Real-World Data Shows Insulin Pumps May Cut Deaths, But Raise Retinopathy Risk in Type 1 Diabetes

Using data from the TriNetX global health research platform, researchers analyzed medical records of over 95,000 individuals with type 1 diabetes between January 2018 and March 2025. After matching cohorts for key factors such as age, gender, ethnicity, kidney function, and baseline HbA1c, 17,124 patients remained in each group — those using insulin pumps and those on MDI.

The key findings of the study were as follows:

• Insulin pump users had a 28% lower risk of all-cause mortality over five years compared to those on multiple daily injections (MDI) (RR = 0.72).
• Pump therapy was associated with a 15% reduction in the risk of diabetic ketoacidosis (DKA) (RR = 0.85).
• Both groups achieved meaningful improvements in glycemic control, with the pump group showing a slightly greater reduction in HbA1c levels (−5.3 mmol/mol) compared to the MDI group (−4.5 mmol/mol).
• Insulin pump users demonstrated a 33% increased risk of developing diabetic retinopathy (RR = 1.33).

While the researchers caution against drawing definitive conclusions from this observation, they suggest that differences in retinal screening frequency between the two groups may have contributed to this result, potentially introducing detection bias.

“These results reflect the everyday use of insulin pumps outside of controlled trial settings and offer valuable insights for diabetes care,” the authors noted. “While pump therapy appears to lower mortality and reduce the risk of DKA, the increased incidence of retinopathy needs further investigation, particularly in the context of screening patterns.”

In summary, the real-world study adds important evidence in favor of insulin pump therapy as a potentially superior option for managing type 1 diabetes. The authors suggest that despite the increased risk of retinopathy, the reductions in DKA and mortality present a compelling case for broader use of pump technology, especially in populations at higher risk of complications.

"As healthcare providers weigh treatment strategies for type 1 diabetes, these findings may help inform more personalized and outcome-driven decisions in clinical practice," the authors concluded.

Reference:

Haughton S, Riley D, Berry S, Arshad MF, Eleftheriadou A, Anson M, Yap YW, Cuthbertson DJ, Malik RA, Azmi S, Alam U, Iqbal A. 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 Obes Metab. 2025 May 19. doi: 10.1111/dom.16455. Epub ahead of print. PMID: 40390300.