LAUSR

Dear Editor, In our previous report performed on 141 people with type 1 diabetes (T1D) with long-term (more than 10 years) use of insulin pump, we have demonstrated that longer period on CSII treatment, in relation to diabetes duration, coined ‘Fractional Use’, is related to lower rates of microvascular and macrovascular diabetes related complications. Four categories of CSII fractional use were analysed: <39%, 39% to 55%, 55% to 75% and >75%. In the present study we subsequently reanalysed the data, in order to rule out reverse causality, that is, higher fractional use is associated with fewer risk factors, thereby associated with less complications. The traditional cardiovascular risk factors that were assessed are: hypertension, hypercholesterolemia, obesity and smoking. History of cardiovascular events (myocardial infarction, stroke) and presence of coronary and peripheral artery disease were also considered. Results – There were no statistical differences in distribution of dyslipidemia, hypertension, cardiovascular disease, smoking history or obesity among the quartiles (Table 1). To find predictors for complications, a Cox Regression was imputed for both univariate (the proportional hazard hypothesis was tested) and multivariate analyses. All parameters (presence of complications) were analysed also in a multivariate model, with a stepwise selection. Variables remained in the model if they were significant at .05 (Table 1). In conclusion, we demonstrated that starting CSII as close as possible to the disease onset plays a protective role against cardiovascular disease independently of the presence of dyslipidemia, hypertension, obesity, smoke, as suggested by the DCCT/EDIC study and the Swedish Diabetes Register. More studies are needed to confirm this hypothesis.