Satisfaction with insulin delivery and glucose monitoring technologies in adults with long-standing type 1 diabetes and recurrent severe hypoglycaemia

Secondary analysis of the HypoCOMPaSS trial highlights greater satisfaction with insulin pump than multiple daily injections

By Christopher Todaro

The UK HypoCOMPaSS trial aimed to prevent severe hypoglycaemia (very low blood glucose; requiring treatment by another person) and improve awareness of hypoglycaemia signs and symptoms among adults with long-standing type 1 diabetes and a high risk of recurrent severe hypoglycaemia. Participants (N=96) were randomly allocated to one of two insulin delivery types and glucose monitoring devices:

  • insulin pump or multiple daily injections
  • real-time continuous glucose monitoring (r-CGM) or self-monitoring of blood glucose (SMBG; using a finger-prick device)

All participants received equivalent education, clinical support and attention, no matter what devices they were allocated to use. Following the 6-month trial, significant improvements were seen in hypoglycaemia awareness and reduction in severe hypoglycaemia. This was achieved regardless of what devices the participant was allocated to use, and without compromising their average blood glucose levels (HbA1c). You can read more about the main results here. In the latest publication from HypoCOMPaSS, Prof Jane Speight and colleagues explore participants’ satisfaction with their insulin administration and glucose monitoring devices.

Regardless of what insulin delivery and glucose monitoring device participants were allocated to during the 6-month trial, participants reported increased satisfaction with their insulin “delivery device” and “hypoglycaemia control”, and greater perceived “effectiveness” of their glucose monitoring device than at baseline. Participants also reported a reduction in the perceived “intrusiveness” of their glucose monitoring device, but no change in the “convenience” of their glucose monitoring experience. These findings were maintained at 2-year follow-up.

Comparing satisfaction between groups, participants allocated to an insulin pump reported greater satisfaction with their “device delivery” than those allocated to multiple daily injections, and there was a trend towards greater satisfaction with “hypoglycaemia control” among those using insulin pumps. However, satisfaction with glucose monitoring experience did not differ between those allocated to CGM and those using a finger-prick device.

In other words, the current study demonstrates significant improvements in treatment satisfaction with both insulin delivery and glucose monitoring devices following the HypoCOMPaSS trial, regardless of allocated device. The original HypoCOMPaSS trial showed that (with appropriate education, clinical support and attention), multiple daily injections are equally effective as insulin pumps in terms of managing glucose levels but general diabetes treatment satisfaction is higher in those allocated to insulin pumps. This secondary analysis expands upon those findings and confirms (with more specific tools) that treatment satisfaction is greater among those using insulin pumps.

For more information, check out our blog on Jane Speight’s collaboration with UK researchers on the HypoCOMPaSS trial.

Speight JHolmes-Truscott E, Little SA, Leelarathna L, Walkinshaw E, Tan HK, Bowes A, Kerr D, Flanagan D, Heller SR, Evans ML, Shaw JAM. Satisfaction with the use of different technologies for insulin delivery and glucose monitoring among adults with long-standing type 1 diabetes and problematic hypoglycaemia: 2-year follow-up in the HypoCOMPaSS Randomised Clinical Trial. Diabetes Technology & Therapeutics, 2019; 21(11): 619-626.