Insulin Pump Therapy

What is the scientific evidence?

Intensive insulin therapy reduces long-term complications

  • Intensive insulin therapy can reduce A1C
  • Lowering A1C reduces long-term complications
  • However, severe hypoglycemia increased as A1C decreased for intensive therapy group (a mix of pump and MDI patients)
  • The methodology flaw in this trial was that participants could choose MDI or pump, and could bounce back and forth between the two
  • Additionally, it should be pointed out that rapid-acting insulin was not yet available
  • This study made it very clear that intensive therapy reduced long-term complications, but it was not clear which method, MDI or pump was more effective

Adapted from DCCT Research Group: N England Journal of Medicine. 1993;329:977-986; "Endocrine Practice" 202, 8 (supp 1), pg 7.
 

What is the scientific evidence?

Pumps lower A1C better than MDI

Yeh HC, et al. Ann Intern Med. 2012;157:336-347
 

What is the scientific evidence?

Pumps reduce hypoglycemic events

Rate ratio 4.19 (95% CI 2.86-6.13)

Pickup JC, Sutton AJ. Diabet Med. 2008;25:765-774.
 

What is the scientific evidence?

Pumps do not increase the rate of DKA

 

·No change compared to MDI: 1 episode during study


These four studies published over an eight-year period all concluded that pumps do not increase the rate of DKA.

Plotnick LP, et al. Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. Diabetes Care 2003;26(4):1142-1146.
Bruttomesso D. Continuous subcutaneous insulin infusion (CSII) in the Veneto region: efficacy, acceptability and quality of life. Diabet Med. 2002;19(8):628-634.
Linkeschova, M, et al. Less severe hypoglycaemia, better metabolic control, and improved quality of life in type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years. Diabetes 2002;19:746-751.
Steindel BS, et al. Continuous subcutaneous insulin infusion (CSII) in children and adolescents with chronic poorly controlled type 1 diabetes mellitus. Diabetes Res Clin Pract. 1995;27(3):199-204.