Tubeless AID Systems Boost HRQoL in Type 1 Diabetes

“Tubeless” automated insulin delivery (AID) systems lead to significant improvements in healthcare-related quality of life (HRQoL) in patients with type 1 diabetes (T1D) compared with other insulin delivery modalities, according to a new study.

The investigators behind the new findings say they offer some of the first research assessing the utility gains associated with tubeless AID systems compared to other delivery systems. The report was published in the journal Diabetic Medicine.

Colin Hopley, M.B.A., M.P.H., the director of value at Insulet Corporation, which funded the study, explained along with colleagues that self-management is critical to diabetes care, no matter the insulin modality. Yet, they noted that the management burden associated with the disease can negatively impact patients’ mental health, “mainly driven by fear of hypo/hyperglycemia and feelings of isolation or self-consciousness.”

The way that patients self-manage their disease has changed significantly in recent years, with many patients changing from self-injections to insulin pumps. That change by itself does not eliminate the burden on patients, Hopley and colleagues argued.

Tubeless insulin pumps — sometimes called patch pumps — are not literally without tubes. But the tube, or cannula, that goes into the skin through which the insulin is delivered is not visible and is encased in a “pod” that sticks to the skin with an adhesive patch.

AID systems use an algorithm to continuously monitor glucose and deliver insulin via a pump as needed. Such symptoms can ease the burden on patients. However, Hopley and colleagues said there is not yet a robust amount of data with regard to the utility gains associated with the newer systems.

The investigators interviewed 110 patients in order to develop health state vignettes representing the different insulin delivery modalities. These vignettes were also informed by published literature and validated by diabetes experts. The authors use the time trade-off analysis method in order to assess the different modalities.

The authors found that tubed non-AID systems had the lowest mean utility values (0.727), while tubeless AID systems had the highest mean utility values (0.909). Tubed AID and tubeless non-AID systems had similar mean utility values of 0.823 and 0.809, respectively.

When the investigators compared the features of the different systems, they found that tubeless systems were associated with a utility increase of between +0.082 and +0.086, while the use of AID increased utility by between +0.096 and +0.100. Both increases were considered statistically significant. In fact, the authors said the magnitude of the benefits they calculated was more than twice as large as those reported in previous studies of T1D. The findings suggest patients using tubeless and AID systems experienced significant HRQoL benefits.

"Results from this study provide a useful resource to demonstrate the disutility associated with conventional insulin delivery systems and utility gains associated with the increased convenience and improved confidence in the management of glucose with both tubeless and AID systems," they wrote.

Hopley and colleagues cautioned that generic vignettes cannot capture the heterogeneity of the lived experiences of individual patients. They said their goal was also to create generalizable utility values that could lend broad insights, rather than to compare individual commercial devices. In that regard, they said their data should be useful in better understanding the HRQoL and economic impacts of different insulin delivery modalities.

"The methods and findings of the current study will allow for these utility values to be used in economic modelling of innovative insulin delivery systems in T1D and may contribute to improving access to these systems among people with T1D," they concluded.