Observational studyBMJ (Clinical research ed.)2015
Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study.
Observational study in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05477030 (Effect of Automated Insulin Delivery With Advanced Closed-loop on Glucose Outcomes and Early-stage Diabetic Complications), which is not on this map. Cited by 90 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effect of Automated Insulin Delivery With Advanced Closed-loop on Glucose Outcomes and Early-stage Diabetic Complications
Who cites it
90 citing papers in PubMed, 2 syntheses or guidelines pooled it, 249 citations in OpenAlex.
- The effects of GLP-1 agonists on HbA1c and insulin dose among patients with type 1 diabetes.Frontiers in endocrinology · 2025Pooled it
- Pooled it
- Effect of metformin on insulin resistance in adults with type 1 diabetes: a 26-week randomized double-blind clinical trial.Nature communications · 2025 · on this mapTrial
- Improved glycaemic control and treatment satisfaction with a simple wearable 3-day insulin delivery device among people with Type 2 diabetes.Diabetic medicine : a journal of the British Diabetic Association · 2018Trial
- Randomized Cross-Over Study Comparing Two Infusion Sets for CSII in Daily Life.Journal of diabetes science and technology · 2017Trial
- Comparison of Different Treatment Modalities for Type 1 Diabetes, Including Sensor-Augmented Insulin Regimens, in 52 Weeks of Follow-Up: A COMISAIR Study.Diabetes technology & therapeutics · 2016Trial
- Day-and-Night Hybrid Closed-Loop Insulin Delivery in Adolescents With Type 1 Diabetes: A Free-Living, Randomized Clinical Trial.Diabetes care · 2016Trial
- Correlation Among Hypoglycemia, Glycemic Variability, and C-Peptide Preservation After Alefacept Therapy in Patients with Type 1 Diabetes Mellitus: Analysis of Data from the Immune Tolerance Network T1DAL Trial.Clinical therapeutics · 2016Trial
- Cardiometabolic risk factors, peripheral arterial tonometry and metformin in adults with type 1 diabetes participating in the REducing with MetfOrmin Vascular Adverse Lesions trial.Diabetes & vascular disease researchTrial
- Type 1 diabetes and cardiovascular medicine.Cardiovascular diabetology. Endocrinology reports · 2026Review
- Diabetes care through video consultations: Insights from people using insulin pump therapy and healthcare professionals-A longitudinal qualitative study.Diabetic medicine : a journal of the British Diabetic Association · 2026Article
- Validation of the ST1RE risk engine in Chinese with type 1 diabetes and comparison with the JADE, RECODe, and UKPDS risk scores.Journal of diabetes investigation · 2026Article
- Real-time autonomic responses to insulin-induced hypoglycaemia in volunteers with type I diabetes compared to controls.IBRO neuroscience reports · 2026Article
- Coronary plaque burden assessed by coronary CT angiography in individuals with type 1 diabetes and healthy controls.The international journal of cardiovascular imaging · 2026Article
- Insulin Delivery Hardware: Pumps and Pens.Diabetes technology & therapeutics · 2026Article
- New Technologies for Blood Glucose Management in Elderly Diabetics: An Interpretation of theAging medicine (Milton (N.S.W)) · 2025Review
- No evidence from euglycaemic-hyperinsulinaemic clamp studies for greater insulin sensitivity in adults with type 1 diabetes using insulin pump versus multiple daily insulin injections-Post hoc meta-analysis.Diabetes, obesity & metabolism · 2025Article
- Article
- The impact of insulin pump therapy compared to multiple daily injections on complications and mortality in type 1 diabetes: A real-world retrospective cohort study.Diabetes, obesity & metabolism · 2025Article
- Novel Insights into the Mechanism and Treatment of Diabetes-Related Brain Complications: Focusing on the Blood-Brain Barrier Impairment.Aging and disease · 2025Review
30 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the long term effects of continuous subcutaneous insulin infusion (insulin pump therapy) on cardiovascular diseases and mortality in people with type 1 diabetes.
designObservational study.
settingSwedish National Diabetes Register, Sweden 2005-12.
participants18,168 people with type 1 diabetes, 2441 using insulin pump therapy and 15,727 using multiple daily insulin injections.
main outcome measuresCox regression analysis was used to estimate hazard ratios for the outcomes, with stratification of propensity scores including clinical characteristics, risk factors for cardiovascular disease, treatments, and previous diseases.
resultsFollow-up was for a mean of 6.8 years until December 2012, with 114,135 person years. With multiple daily injections as reference, the adjusted hazard ratios for insulin pump treatment were significantly lower: 0.55 (95% confidence interval 0.36 to 0.83) for fatal coronary heart disease, 0.58 (0.40 to 0.85) for fatal cardiovascular disease (coronary heart disease or stroke), and 0.73 (0.58 to 0.92) for all cause mortality. Hazard ratios were lower, but not significantly so, for fatal or non-fatal coronary heart disease and fatal or non-fatal cardiovascular disease. Unadjusted absolute differences were 3.0 events of fatal coronary heart disease per 1000 person years; corresponding figures were 3.3 for fatal cardiovascular disease and 5.7 for all cause mortality. When lower body mass index and previous cardiovascular diseases were excluded, results of subgroup analyses were similar to the results from complete data. A sensitivity analysis of unmeasured confounders in all individuals showed that an unmeasured confounders with hazard ratio of 1.3 would have to be present in >80% of the individuals treated with multiple daily injections versus not presence in those treated with pump therapy to invalidate the significantly lower hazard ratios for fatal cardiovascular disease. Data on patient education and frequency of blood glucose monitoring were missing, which might have influenced the observed association.
conclusionAmong people with type 1 diabetes use of insulin pump therapy is associated with lower cardiovascular mortality than treatment with multiple daily insulin injections.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.