Tubed or tubeless insulin pumps? A retrospective real-world analysis of national French health data

Background Tubeless insulin pumps, introduced in France in 2016, have been associated with higher user satisfaction than tubed pumps, primarily due to reduced interference with daily tasks. Whether this translates to greater treatment persistence remains uncertain. This study evaluates persistence among people with type 1 diabetes initiating tubed or tubeless pump therapy in France.Methods This real-world, retrospective study used data from the French National Health Data System, a comprehensive medical claims database for the entire French population from 2016 to 2021. Treatment persistence was assessed using Kaplan-Meier curves and Cox models. Changes from one pump type to another were compared across calendar years using χ2 tests.Results Among 1 241 624 people with insulin claims, 233 874 had type 1 diabetes. Of these, 39% (n=90 362) initiated insulin therapy during the study period; 32% started and remained on multiple daily injections (excluded), and 68% initiated pump therapy. Among pump users (n=61 251), 51% used a tubed pump, 67% a tubeless pump, and 18% initiated both types sequentially. People initiating tubeless compared with tubed pumps had higher persistence rates (unadjusted HR 0.60, 95% CI 0.58 to 0.61) and a 40% lower risk of discontinuation (p<0.0001), consistent with the adjusted model (HR 0.59, 95% CI 0.57 to 0.61). Tubeless pumps were also associated with fewer changes from one therapy to another within 12 months. Treatment changes rose for tubed pump users after tubeless pumps entered the French market.Conclusions Higher persistence and lower therapy changes among tubeless pump users underscore its sustained benefit for diabetes management.