Does the insulin pump benefit all? Psychological issues and diabetes treatments

This study examined the effect of psychological illness, such as depression or anxiety, on glycemic control in type 1 diabetics using insulin pumps (continuous delivery of insulin).

Continuous subcutaneous insulin infusion, or the insulin pump, introduces an ongoing amount of insulin into the body, without the patient having to worry about multiple daily injections. This type of treatment can improve glycemic control (stabilize blood glucose [sugar] levels), particularly in patients with hard-to-control, or “brittle”, diabetes, and for many can improve quality of life and feelings of normalcy. However, this is not true of all patients.

Little research has examined the role of psychological illness in diabetes control. Young patients, in particular, often discontinue use of the insulin pump due to social and psychological factors. It has been suggested that patients’ psychological background could assist in determining if they are likely to benefit from an insulin pump. However, whether or not these psychological issues are part of the reason behind poor glycemic control or whether they can predict which patients are not suitable for insulin pumps is not clear.

The current study examined the records of 575 type 1 diabetes patients, to assess the prevalence of psychological illness and the success of these patients at achieving glycemic control. 225 of the patients had not used an insulin pump, while the other 350 were continuing insulin injection therapy. HbA1c (average blood glucose levels over 3 months) levels, episodes of hypoglycemia (dangerously low blood glucose), and the presence of mental health problems was recorded at the start of insulin pump therapy, and then again 6–12 months later.

At the beginning of the study, the two groups did not differ significantly in HbA1c levels, but hypoglycemia was more problematic for those beginning use of the insulin pump. There was also a higher percentage of patients reporting psychological problems, such as depression and anxiety, in the insulin pump group (51% of patients compared to 40% of patients).

After 6-12 months of insulin pump therapy, patients with no psychological problems had a significant decrease in HbA1c levels (1.0%). However, patients with depression only had a 0.5% decrease in HbA1c levels and patients with anxiety only had a 0.4% decrease in HbA1c levels. The severity of hypoglycemia decreased significantly in patients with no psychological disorders (69% decrease in severity) and patients with anxiety (81% decrease in severity), while patients with depression only had a 58% decrease in their hypoglycemia severity after 6-12 months of insulin pump therapy.

The study concluded that insulin pump use in patients with psychological problems does not improve their glycemic control as well as for patients with no psychological problems. The authors suggest that assessing psychological issues prior to starting treatment may be helpful in disease management.