Insulin Pumps May Outperform Daily Injections for Type 2 Diabetes: Study
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Insulin pumps are small devices that are worn by patients and deliver constant amounts of insulin to the body through a catheter placed under the skin.
The multicenter, international study was funded by medical device maker Medtronic and included 331 people aged 30 to 75. All of the patients had poorly controlled type 2 diabetes and were using multiple daily injections of insulin to control their blood sugar levels.
The patients were randomly assigned to either continue using injections or to switch to an insulin pump.
After six months, patients who used the insulin pumps had a much greater reduction in average blood sugar levels than those who used injections, the study found. According to the researchers, twice as many patients in the pump group reached the blood sugar control target range (55 percent vs. 28 percent).
By the end of the study, patients in the pump group required a 20 percent lower daily dose of insulin than those in the injection group. Patients in the pump group also averaged nearly three hours less per day with high blood sugar than those in the injection group, the team reported July 2 in The Lancet.
According to the study, the amount of time people spent with extremely low blood sugar remained similarly low in both the pump and injection groups.
"Our findings open up a valuable new treatment option for those individuals [who are] failing on current injection regimens," study author Yves Reznik, from the University of Caen Cote de Nacre Regional Hospital Center in France, said in a journal news release. He believes that the devices "may also provide improved convenience, reducing the burden of dose tracking and scheduling, and decreasing insulin injection omissions."
Two experts in the United States weren't surprised by the findings.
"Many people with type 2 diabetes work hard to maximize the benefit of multiple daily injections of insulin but still struggle to keep their blood glucose values in target range," said Virginia Peragallo-Dittko, executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola, N.Y.
Dr. Gerald Bernstein directs the Diabetes Management Program at the Friedman Diabetes Institute, part of Beth Israel Medical Center in New York City. He believes that insulin pumps may be the future of diabetes care, but hurdles remain.
Because of insurance-related "inhibitors in our health care system," use of the devices "has not become common practice in the U.S.," Bernstein said.
While daily self-injections have been the standard of care for decades, "for many [patients] where personal discipline plays a role, injections just don't do it," Bernstein said. Making the switch to an insulin pump also means that "you also need a sophisticated diabetes educator and pump trainer," he added.
However, Bernstein believes that "the future is bright -- pump and continuous monitor use is increasing, which should mean a reduction in price. All of the effort is to improve quality of life, productivity and reduce the risk for complications."
-- Robert Preidt
SOURCES: Virginia Peragallo-Dittko, R.N., executive director, Diabetes and Obesity Institute, Winthrop-University Hospital, Mineola, N.Y.; Gerald Bernstein, M.D., director, Diabetes Management Program, Friedman Diabetes Institute, Beth Israel Medical Center, New York City; The Lancet, news release, July 2, 2014