Insulin Pump and CGM Usage in the United States and Germany

Abstract

Background: This survey collected and evaluated user responses about routine tasks and preferences regarding insulin pumps and infusion sets (IIS) with comparison of intercountry differences between the United States (US) and Germany (GER), chosen for their large insulin pump populations. Methods: A total of 985 subjects (534 US, 451 GER; 60% female) with type 1 diabetes on pump therapy anonymously answered 20 pump-related questions. US subjects also answered 11 questions about continuous glucose monitoring (CGM) usage. Results: Length of use of insulin cartridges is shorter in US than in GER, mean (SD) 4.3 (5.0) versus 5.3 (3.2) days ( P < .001), while the IIS is used longer: 3.3 (1.0) versus 2.7 (1.1) days ( P < .001). Lower self-reported HbA1c levels were associated with longer use of insulin cartridges (7.3% for >3 days vs 7.7% for <3 days; P < .01), and with use of an auto-insertion device (vs manual IIS insertion) in the US (7.2% vs 6.9%), but not in GER (7.7% vs 7.9%). Only 47% of pump wearers stated that they were “very satisfied” with their pump (49% US vs 45% GER, ns). However, 98% would recommend the pump to others (95% vs 93%, ns). Analysis of CGM questions showed that 297 (60%) of 496 US responders currently wore one. Of these, 84% said they would recommend CGM to others. CGM wearers who stated they were “very satisfied” with their CGM had lower HbA1c than those who said they were “partly satisfied” (6.9% vs 7.2%). Conclusions: This survey shows interesting differences in real-world use of insulin pumps in 2 large markets, and suggests areas where insulin pumps and CGMs might be improved.