Responsabilidades de autocuidado acordes a la edad en población pediátrica con diabetes tratada con ISCI / Age-appropriate self-care responsibilities in the pediatric population with diabetes treated with CSII

Objetivo: Determinar en población infantil con Diabetes tipo 1 (DT1) en tratamiento con infusión subcutánea continua de insulina (ISCI), si asumir responsabilidades de autocuidado tras recibir un programa estructurado de educación terapéutica (PEET) se relaciona con el control metabólico y la calidad de vida (CV). Métodos: Estudio observacional, transversal. Se realizó un sub-análisis retrospectivo. Se incluyeron sujetos con DT1 (edad 9-17 años) en terapia ISCI (>1año) que habían recibido el mismo PEET al inicio de ISCI. Se registraron: grado en que asumían responsabilidades de autocuidado acordes a su edad, control metabólico, CV, nivel de conocimientos sobre diabetes y uso de funciones específicas del dispositivo. Resultados: Se incluyeron 44 pacientes. Los niños que asumieron responsabilidades de autocuidado acordes a su edad presentaron valores de hemoglobina glicada (HbA1c) significativamente menores que los niños que no las asumieron (8,0±0,7% vs. 9,2±1,1%, respectivamente, p<0,001), así como una mayor puntuación en los cuestionarios de CV y de conocimientos (CV 84,3±9,3 vs. 79,4±10,6, p<0,01; conocimientos 27,9±4,2 vs. 26,5±4,3, respectivamente, n.s). El uso de las funciones específicas de la bomba se observó principalmente en aquellos que asumieron esas responsabilidades de autocuidado presentando valores más bajos de HbA1c que aquellos niños que no las utilizaron (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusiones: Los pacientes con DT1 en tratamiento con ISCI que asumieron responsabilidades de autocuidado de su diabetes acorde a su edad, mostraron mejor control de HbA1c y mejor CV que aquellos que no lo hicieron. Se necesitan más estudios para profundizar en el conocimiento de estos aspectos. (AU)

Objective: The aim of this study was to determine if children and adolescents with type 1 diabetes (DT1) managed with continuous subcutaneous insulin infusion (ISCI) who assume self-care responsibilities tailored to the age after a specific structured education program (PEET), present better metabolic control and quality of life (CV). Methods: A observational, cross-sectional study was conducted. A retrospective sub-analysis was performed. Subjects with DT1 (aged 9-17 years) who have been using ISCI (>1year) were included. All patients received the same structured PEET when initiating ISCI treatment. The degree of self-care age-appropriate responsibilities assumed by children was registered. Data related to metabolic control, diabetes knowledge, use of different pump features, and quality of life were also collected. Results: Forty-four patients were included. Children assuming age-appropriate self-care responsibilities had a significantly lower glycated hemoglobin (HbA1c) value compared to those children who did not take on these responsibilities (8,0±0,7% vs. 9,2±1,1%, p<0,001). as well as higher scores in the CV and knowledge questionnaires (84,3±9,3 vs. 79,4±10,6 respectively, p<0,01; knowledge 27,9±4,2 vs. 26,5±4,3, respectively, n.s). The use of specific pump features was mainly observed in those who assumed age-appropriate self-care responsibilities and showed lower HbA1c values than those children who did not take on these responsibilities (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusion: Patients with DT1 managed with ISCI, who assumed age-appropriate responsibilities on disease self- management, showed better HbAc1 and better CV than those who did not. More studies are needed to deepen the knowledge of these topics. (AU)

Psychometric analysis of the cross-cultural Spanish version of the diabetes management questionnaire.

Evaluation of the degree of adherence to self-care among Spanish type 1 diabetes (T1DM) pediatric population lacks of a validated tool. PURPOSE: To cross-culturally adapt and determine the psychometric properties of the Spanish version of the Diabetes Management Questionnaire to assess the degree of adherence to self-care among children with T1DM. METHODS: Translation, back-translation, and patient suggestions, were considered to obtain the Spanish version (DMQ-Sp). A cross-sectional study was conducted with 323 children (aged 8-18 years) with T1DM and their parents to determine internal reliability, structural validity, and external validity. Responsiveness to change was analyzed through a prospective longitudinal study involving 102 newly diagnosed T1DM patients. Psychometrics were evaluated for the entire sample and stratified by age (8-12 and 13-18 years). RESULTS: A total of 323 children with T1DM [49.8% female; age 13.3 ± 2.8 years; 155 aged 8-12; glycated hemoglobin (HbA1c) value 7.7 ± 1.0%] answered the Spanish final version. The internal consistency Cronbach's alpha was 0.76 and intraclass correlation coefficient 0.84. Test-retest reliability was r = 0.84 (p < 0.001). Fit index of structural validity was >0.7. External validity correlated inversely with HbA1c (r = -0.39; p < 0.001). The DMQ-Sp score increased significantly after 6 months of receiving the full therapeutic education program (TEP) (baseline 57.07 ± 10.81 vs. 6 months 78.80 ± 10.31; p < 0.001). CONCLUSION: The DMQ-Sp is reliable, valid, and sensitive to change in a large sample of children (aged 8-18 years) with T1DM and their parents. PRACTICE IMPLICATIONS: DMQ-Sp can be a useful tool for diabetes teams to identify adherence to different tasks and to evaluate TEPs.

Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital.

Introduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. Material and Methods: Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. Discussion and conclusions: Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.

A therapeutic education program with a diabetes specialist nurse for type 2 diabetes patients using insulin in a primary care setting. A diabetes education program with a diabetes specialist nurse in a primary care setting.

INTRODUCTION: Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2 insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS: A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS: 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34%±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; p<0.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (p<0.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION: A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.

A Therapeutic Education Program with a Diabetes Specialist Nurse for Type 2 Diabetes Patients Using Insulin in a Primary Care Setting. A Diabetes Education Program with a Diabetes Specialist Nurse in a Primary Care Setting. / Resultados del programa de educación terapéutica de optimización dirigido a pacientes insulinizados con diabetes tipo 2 desarrollado por enfermería de práctica avanzada en diabetes en el ámbito de atención primaria.

INTRODUCTION: Therapeutic education is an essential part in the management of type 2 diabetes mellitus (T2D). Implementing a therapeutic education program with the participation of a diabetes specialist nurse (DSN) addressed to patients with T2D using more than 2insulin injections and sub-optimal metabolic control in primary care (PC) could improve health care and clinical outcomes. Our purpose was to evaluate the clinical, educational and patient satisfaction outcomes of this program. MATERIAL AND METHODS: A prospective, longitudinal study was performed with an evaluation before and after the intervention. The program had a duration of 6 months and included individual on-site, phone and group visits. RESULTS: 184 subjects were included and 161 were finally evaluated. 89.4% were included due to sub-optimal metabolic control and 10.6% because of repeated hypoglycemia. In the first group, the mean reduction in HbA1c was -1.34±1.45% without any increase in hypoglycemia episodes. In the second group, a significant reduction in hypoglycemia episodes/week was observed (2.52±1.66 vs. 0.53±1.06; P<.05) without any increase in HbA1c. Learning skills, lifestyle, adherence to care, and the perception of quality of life had significantly improved at 6 months (P<.05). The overall program was positively evaluated by patients, the role of DSN being considered essential by 98% of the responders. CONCLUSION: A structured therapeutic education program, including a DSN, addressed to insulin treated T2D patients attending primary care facilities and with sub-optimal metabolic control is associated with beneficial effects in terms of clinical, educational and patient satisfaction endpoints.

Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade. / Resultados de un programa específico y estructurado en la transición de pacientes jóvenes con diabetes tipo 1 desde pediatría a un hospital de adultos. La experiencia de una década.

OBJECTIVE: Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGY: This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTS: A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.

Programa de Atención y Educación Terapéutica dirigido a jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico al hospital de adultos. Percepción de las enfermeras / Therapeutic education program addressed to young people with type 1 diabetes transferred from the pediatric center to the adult hospital

El traslado de los jóvenes con diabetes tipo 1 desde los centros pediátricos a las unidades de adultos se realiza durante la adolescencia, periodo caracterizado por cambios fisiológicos y psicológicos que los hace especialmente vulnerables. En este periodo se aconseja que las familias y/o cuidadores trasladen, en parte, la responsabilidad del manejo de la diabetes a los jóvenes de forma progresiva. El cambio de rol en el autocuidado, de centro y de profesionales añadido a la gran vulnerabilidad se relaciona con el empeoramiento del control metabólico y pérdida de seguimiento asistencial. Se requieren programas educativos específicos, estructurados y coordinados con los centros pediátricos para minimizar los posibles efectos adversos del traslado y mantener y/o mejorar el control metabólico y la calidad de vida de estos jóvenes. Siguiendo las recomendaciones de la Sociedad Española de Diabetes y la Sociedad Española de Endocrinología Pediátrica, presentamos la estructura, el proceso y los resultados del programa de acogida a los jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico de Sant Joan de Déu al Hospital Clínic de Barcelona, durante el primer año después del traslado

The transfer of young people with type 1 diabetes from pediatric centers to adult units takes place during adolescence, a period characterized by physiological and psychological changes that make them especially vulnerable. In this period it is recommended that families and /or caregivers progressively leave the responsibility of managing diabetes to the young people themselves. The change of role in self-care, center and professionals in addition to the inherent vulnerability is related to the worsening of metabolic control and loss of these patients to follow-up care. Specific educational programs are required, which are structured and coordinated with the pediatric centers to minimize the possible adverse effects of the transfer and maintain and / or improve the metabolic control and the quality of life of these young people. Following the recommendations of the Spanish Society of Diabetes and the Spanish Society of Pediatric Endocrinology, we present the structure, process and results of the reception program for young people with type 1 diabetes transferred from the pediatric center of Sant Joan de Déu to the Hospital Clínic of Barcelona during the first year after the transfer

Trasplante aislado de páncreas en diabetes tipo 1 de control lábil: A propósito de 3 casos / Isolated pancreas transplantation in patients with brittle type 1 diabetes: A report of 3 cases

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Enfermedad cardiovascular en la diabetes mellitus tipo 1. Más que mera coincidencia / Cardiovascular disease in type 1 diabetes mellitus. More than single chance

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Nuevos tratamientos de la diabetes mellitus tipo 2. Mucho ruido y algunas nueces / New treatments for Type 2 Diabetes. Much a do for nothing

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[Prevalence of the metabolic syndrome in Spanish patients with established cardiovascular disease: CLYDIA study]. / Prevalencia del síndrome metabólico en pacientes con enfermedad cardiovascular en España: estudio CLYDIA.

BACKGROUND AND OBJECTIVE: To assess the prevalence of metabolic syndrome (MS) and cardiovascular risk factors in patients with established cardiovascular disease (CVD). PATIENTS AND METHOD: Epidemiologic, cross-sectional, multicentre and national study. 1,342 evaluable patients were recruited by 95 physicians of primary care, cardiology, endocrinology and internal medicine. All patients had confirmed diagnosis of CVD (myocardial infarction, coronary disease, ischaemic cerebrovascular disease and/or peripheral vascular disease) and analytical data for the study of MS according to Adult Treatment Panel-III (MS identified as presence of at least 3 components: abdominal obesity, triglycerides > or = 150 mg/dl, high density lipoproteins-cholesterol < 40 mg/dl in men and < 50 mg/dl in women, blood pressure > 130/85 mmHg and fasting glucose > 110 mg/dl). RESULTS: 37% (n = 497) of patients presented MS, with a higher prevalence among women (51.5% versus 31.8%) (chi2 test, p < 0.0001). 58% of patients had abdominal obesity, 50.4% hyperglycemia, 39.7% hypertriglyceridemia, 34.4% low values of high density lipoproteins-cholesterol and 28% high blood pressure. Abdominal obesity (86.7%) and hyperglycemia (82.7%) were the most prevalent components among patients with MS. Previous ischaemic cerebrovascular disease was more prevalent among patients with MS (22.3% versus 17.5%) (chi2 test, p < 0.05), as well as family history of hypertension, diabetes, ischaemic cardiopathy and ischaemic cerebrovascular disease (49.1%, 46.3%, 41.1% and 27.5%) (chi2 test, p < 0.05). Patients with MS showed a higher probability of suffering cardiac event in the next 10 years (25.3% vs. 17.4%). CONCLUSIONS: The prevalence of MS among Spanish population with CVD is high, specially among women.

Prevalencia del síndrome metabólico en pacientes con enfermedad cardiovascular en España: estudio CLYDIA / Prevalence of the metabolic syndrome in Spanish patients with established cardiovascular disease: CLYDIA study

Fundamento y objetivo: El propósito del presente estudio ha sido evaluar la prevalencia del síndrome metabólico (SM) y de los factores de riesgo cardiovascular en pacientes con enfermedad cardiovascular (ECV). Pacientes y método: Se ha realizado un estudio epidemiológico, transversal, multicéntrico y nacional. Un total de 95 profesionales de atención primaria, cardiología, endocrinología y medicina interna incluyeron a 1.342 pacientes valorables con diagnóstico clínico de ECV (infarto de miocardio, enfermedad coronaria, enfermedad cerebrovascular isquémica y/o enfermedad vascular periférica) y determinaciones analíticas para establecer el posible diagnóstico de SM según los criterios del Adult Treatment Panel-III (presencia de al menos 3 de los siguientes componentes: obesidad abdominal, triglicéridos >= 150 mg/dl, colesterol unido a lipoproteínas de alta densidad 130/85 mmHg y glucemia en ayunas > 110 mg/dl). Resultados: El 37% (n = 497) de la población presentaba SM, con una prevalencia mayor entre las mujeres (el 51,5 frente al 31,8%) (prueba de la *2, p < 0,0001). Un 58,0% de los pacientes presentaba obesidad abdominal; un 50,4%, hiperglucemia; un 39,7%, hipertrigliceridemia; un 34,4%, concentraciones bajas de colesterol unido a lipoproteínas de alta densidad, y un 28%, presión arterial alta. La obesidad abdominal (86,7%) y la hiperglucemia (82,7%) fueron también los componentes más prevalentes en la población con SM. Los antecedentes de enfermedad cerebrovascular isquémica fueron más prevalentes en pacientes con SM (el 22,3 frente al 17,5%) (prueba de la *2, p < 0,05), así como los antecedentes familiares cardiovasculares en general: hipertensión, diabetes, cardiopatía isquémica y accidente vascular cerebral/accidente isquémico transitorio (el 49,1, el 46,3, el 41,1 y el 27,5%, respectivamente) (prueba de la *2, p < 0,05). Los pacientes con SM mostraron mayor probabilidad de sufrir un evento cardíaco en los 10 años siguientes (un 25,3 frente al 17,4%). Conclusiones: La población española con ECV presenta elevada prevalencia de SM, especialmente en mujeres

Background and objective: To assess the prevalence of metabolic syndrome (MS) and cardiovascular risk factors in patients with established cardiovascular disease (CVD). Patients and method: Epidemiologic, cross-sectional, multicentre and national study. 1,342 evaluable patients were recruited by 95 physicians of primary care, cardiology, endocrinology and internal medicine. All patients had confirmed diagnosis of CVD (myocardial infarction, coronary disease, ischaemic cerebrovascular disease and/or peripheral vascular disease) and analytical data for the study of MS according to Adult Treatment Panel-III (MS identified as presence of at least 3 components: abdominal obesity, triglycerides >= 150 mg/dl, high density lipoproteins-colesterol 130/85 mmHg and fasting glucose > 110 mg/dl). Results: 37% (n = 497) of patients presented MS, with a higher prevalence among women (51.5% versus 31.8%) (*2 test, p < 0.0001). 58% of patients had abdominal obesity, 50.4% hyperglucemia, 39.7% hypertriglyceridemia, 34.4% low values of high density lipoproteins-cholesterol and 28% high blood pressure. Abdominal obesity (86.7%) and hyperglucemia (82.7%) were the most prevalent components among patients with MS. Previous ischaemic cerebrovascular disease was more prevalent among patients with MS (22.3% versus 17.5%) (*2 test, p < 0.05), as well as family history of hypertension, diabetes, ischaemic cardiopaty and ischaemic cerebrovascular disease (49.1%, 46.3%, 41.1% and 27.5%) (*2 test, p < 0.05). Patients with MS showed a higher probability of suffering cardiac event in the next 10 years (25.3% vs. 17.4%). Conclusions: The prevalence of MS among Spanish population with CVD is high, specially among women

Coste-utilidad de las bombas de insulina en el tratamiento de la diabetes tipo 1 en España. Cuando lo más caro puede ser lo mejor (o no) / Cost-utility of insulin pumps in the treatment of type 1 diabetes in Spain. When most expensive is best (or not)

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[Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain]. / Análisis coste-utilidad de las bombas de insulina frente a múltiples dosis diarias en pacientes con diabetes mellitus tipo 1 en españa.

BACKGROUND: The use of continuous subcutaneous insulin infusion (CSII) for treating Type I diabetes mellitus (DM1) has been related to better metabolic control compared it to daily multiple insulin injections (DMI) and thus to a lowering of the related costs. However, this therapy is now being used to a lesser extent due, at least partially, to the higher initial cost of purchase. This study is aimed at estimating the clinical and economic consequences of using CSII as compared to DMI by means of a cost-utility analysis. METHODS: A mathematical simulation model was adapted using nationwide clinical and economic data to simulate the long-term clinical and economic consequences for a DM1 patient. The time horizon was the patient's lifetime, including only direct healthcare costs and updating both costs and benefits at an annual 3% rate. RESULTS: In the basecase, the patients treated using CSII gained 0.890 years (p < 0.05) and 0.852 QALYs (p < 0.05). CSII treatment gives rise to an incremental average cost of 25,523 Euro (p < 0.05) per patient treated, which gave us an incremental cost- utility ratio of 29,947 Euro-QALY [CI 95% (29,519; 30,375)]. CONCLUSIONS: The improvement in the glucose control among those patients treated using CSII was related to an overall lower cost in the handling of DM1 patients, which was found to have a favourable cost-utility ratio in comparison to conventional MDI treatment.

Análisis coste-utilidad de las bombas de insulina frente a múltiples dosis diarias en pacientes con diabetes mellitus tipo 1 en España / Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain

Fundamento: El uso de bombas de infusión continua de insulina(BICI) para la diabetes mellitus tipo 1 (DM1) se ha relacionadocon un mejor control metabólico al compararlo con las múltiplesdosis de insulina (MDI). Este mejor control puede traducirse en unadisminución de las complicaciones asociadas a la DM1 y por lo tantouna reducción de los costes asociados. Sin embargo el uso de estaterapia ha quedado mermado, al menos en parte, debido a su mayorcoste inicial de adquisición. El objetivo del presente estudio fue estimarlas consecuencias clínicas y económicas del uso de BICI frentea MDI a través de un análisis de coste-utilidad.Métodos: Se adaptó un modelo matemático de simulación queemplea datos clínicos y económicos de ámbito nacional, para simularlas consecuencias clínicas y económicas a largo plazo de unpaciente con DM1. El horizonte temporal fue el de toda la vida delpaciente, incluyendo sólo costes directos sanitarios, y actualizandotanto costes como beneficios a una tasa del 3% anual.Resultados: En el caso base los pacientes tratados con BICIexperimentaron una ganancia de vida de 0,890 años (p<0,05) y 0,852AVACs (p<0,05). El tratamiento con BICI produce un coste medioincremental de 25.523 ? (p<0,05) por paciente tratado, lo que noscondujo a un ratio coste- utilidad incremental de 29.947 ?/AVAC [IC95% (29.519, 30.375)].Conclusiones: La mejora en el control glucémico en pacientescon BICI se asoció a una reducción del coste global del manejo depacientes con DM1, y resultó tener una relación coste-utilidad favorableal compararla con el tratamiento convencional MDI(AU)

Background: The use of continuous subcutaneous insulin infusion(CSII) for treating Type I diabetes mellitus (DM1) has beenrelated to better metabolic control compared it to daily multipleinsulin injections (DMI) and thus to a lowering of the related costs.However, this therapy is now being used to a lesser extent due, atleast partially, to the higher initial cost of purchase. This study isaimed at estimating the clinical and economic consequences ofusing CSII as compared to DMI by means of a cost-utility analysis.Methods: A mathematical simulation model was adapted usingnationwide clinical and economic data to simulate the long-term clinicaland economic consequences for a DM1 patient. The time horizonwas the patient's lifetime, including only direct healthcare costsand updating both costs and benefits at an annual 3% rate.Results: In the basecase, the patients treated using CSII gained0.890 years (p<0.05) and 0.852 QALYs (p<0.05). CSII treatmentgives rise to an incremental average cost of 25,523 ? (p<0.05) perpatient treated, which gave us an incremental cost- utility ratio of29,947 ?/QALY [CI 95% (29,519; 30,375)].Conclusions: The improvement in the glucose control amongthose patients treated using CSII was related to an overall lower costin the handling of DM1 patients, which was found to have a favourablecost-utility ratio in comparison to conventional MDI treatment(AU)