A new study has shown that insulin pumps are much more effective, compared to injections, when it come to controlling blood sugar.
Associate Professor Elizabeth Davis, Princess Margaret Hospital for Children, Perth, WA, Australia and colleagues conducted the study.
In the study, a total of 345 patients on pump therapy were matched to controls on injections, with a mean age 11 years (range 2-19 years), with a mean duration of diabetes at the start of pump therapy of 4.1 years (range 6 months to 15.5 years) and a follow up of 3.5 years (range 0-10.5 years). The mean HbA1c reduction (a standard method for measuring blood glucose control) in the pump cohort was 0.6 percent (6.6 mmol/mol).
This improved HbA1c remained significant until seven years of follow up (at which point the numbers in the study were too small to analyse the results with statistical confidence). Both groups started with the same HbA1c and max difference was 1 percent difference at 6 yrs: 7.6 percent in the pump group and 8.6 percent in the non-pump group.
Pump therapy reduced episodes of severe hypoglycaemia (dangerously low blood glucose) from 14.7 to 7.2 events per 100 patients per year.
In contrast, severe hypoglycaemia increased in the non-pump cohort over the same period from 6.8 to 10.2 events per 100 patients per year (probably due to random variation).
The rate of admission for diabetic ketoacidosis (a shortage of insulin causing the body to switch to burning fats and producing acidic ketone molecules which cause complications and symptoms, a frequent complication in children with T1DM) was lower in the pump cohort than in the non-pump cohort (2.3 vs 4.7 per 100 patients per year) during follow up.
Of the 345 patients on pump therapy, 38 ceased pump therapy during the course of the study; 6 of these were in the first year of treatment, 7 in the second year of treatment, 10 in the third year of treatment with the remainder ceasing treatment after at least 3 sequential years on pump therapy.
Some children stop because they become tired of the extra attention needed to manage pump and/or concerned about the physical sight of the pump. Other children sometimes take a temporary ‘pump holiday’ and then recommence pump use.
The research has been published in Diabetologia, the journal of the European Association for the Study of Diabetes.