SUN-522 - Insulin Delivery Modality Matters: Lower Readmission and Mortality with Pump Therapy in Hospitalized Adults with Type 1 Diabetes - Evidence from the Nationwide Readmissions Database

Context: Adults with type 1 diabetes mellitus (T1DM) experience substantial inpatient morbidity, including frequent hospital readmissions and measurable in-hospital mortality, contributing significantly to health care utilization in the United States.

Objective: To evaluate the association between insulin delivery modality and 30-day all-cause readmission and in-hospital mortality among adults hospitalized with T1DM.

Design, Setting, and Participants: Retrospective cohort study using the 2022 Nationwide Readmissions Database (NRD), a nationally representative all-payer inpatient database. Adult patients (≥18 years) hospitalized with T1DM were identified using ICD-10-CM diagnosis codes. Index admissions were defined as the first eligible hospitalization per patient within the calendar year. December and elective admissions were excluded to allow complete 30-day follow-up.

Exposure: Insulin delivery modality during index admission, categorized as insulin pump therapy (± injectable insulin) versus injectable insulin only.
Main Outcomes and Measures: The primary outcome was time to first all-cause readmission within 30 days of discharge. Secondary outcomes included in-hospital mortality during index admission and during readmission. Survey-weighted Cox proportional hazards and logistic regression models were used to estimate adjusted hazard ratios (aHRs) and odds ratios (aORs), accounting for demographic, socioeconomic, hospital-level, and clinical covariates.

Results: The weighted cohort represented 230,958 adult index admissions with T1DM. The 30-day readmission rate was 14.6% among insulin pump users and 20.6% among patients treated with injectable insulin only. Insulin pump therapy was independently associated with a lower risk of 30-day readmission (aHR, 0.77; 95% CI, 0.74–0.81; P< 0.001). In-hospital mortality during the index admission was lower among pump users (0.90% vs 1.31%). After multivariable adjustment, insulin pump therapy remained associated with reduced odds of in-hospital death (aOR, 0.78; 95% CI, 0.66–0.93; P=0.006). Associations were consistent across prespecified subgroups, including chronic kidney disease, diabetic ketoacidosis, and ICU admission status.

Conclusion: In a nationally representative 2022 cohort, insulin pump therapy was associated with significantly lower 30-day readmission and in-hospital mortality among adults hospitalized with T1DM, suggesting insulin delivery modality may represent a modifiable determinant of inpatient outcomes and health care utilization.

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