Insulin Pumps May Have Advantage in Type 1 Diabetes

A new evidence review suggests that people with type 1 diabetes may achieve better blood sugar control by using a pump to deliver insulin continuously instead of taking three or more daily injections.

“The findings of this review tell us that both continuous subcutaneous insulin infusion and multiple injections correct blood glucose levels. However, [continuous infusion] may be better for reducing harmful fluctuations in blood glucose,” says lead author Marie Misso, PhD.

“There are numerous studies that evaluate these treatments, but most are of poor quality,” says Misso, a research fellow at the Monash Institute of Health Services Research in Clayton, Australia. “So there has been uncertainty about which treatment is best for maintaining consistent levels of blood glucose and reducing harmful fluctuations.”

In the new review, published in The Cochrane Library, Misso and colleagues analyzed the results of 23 studies that randomly assigned 976 adults and children to one of the two interventions. Researchers looked at measures such as levels of hemoglobin A1c (HbA1c) and at the incidence of both high and low blood glucose.

While participants using the insulin pump had significantly lower HbA1c levels than those using multiple daily injections, no differences existed between the two for nonsevere low blood glucose levels. However, there appeared to be a reduction in severe incidents of low blood glucose among those using the pump.

“Good evidence is now available to support the use of continuous subcutaneous insulin infusion in the appropriate patient. It is essential to consider adverse events, late complications of diabetes, mortality, and cost when deciding whether [a pump] is appropriate for the patient,” Misso says.

For people who will likely deal with their disease for the rest of their life, convenience is another consideration.

Pump users have the advantage of being able to avoid potentially painful injections several times per day. In addition, pumps deliver the medication without the user having to find a private place to administer the injection.
The downsides to pump use include having to wear it like a pager or cell phone throughout the day, concerns about protecting the tubing that goes into the body—although wireless pumps have recently become available—and worries about breaking the pump during rough play or exposure to water.

Ramin Alemzadeh, MD, director of the Diabetes Program at the Children’s Hospital of Wisconsin in Milwaukee, cautions that although the researchers reported that pumps may improve overall glucose control, pediatric patients should not expect major changes in the longer term control of blood glucose.

“In our experience, we don’t see a significant overall blood glucose improvement beyond six months or one year of treatment in most children and adolescents. Initially, the patient’s HbA1c levels improve, but after a while levels begin to rise and are not significantly different from where they started,” Alemzadeh says. “A patient’s diabetes management starts with them and their family. How well they do is independent of which method of insulin administration they use.”

Source: Health Behavior News Service