In a nutshell
This study investigated the effects of switching from multiple insulin injections to a continuous insulin pump in patients with type 1 diabetes. They concluded that insulin pump therapy effectively improved blood sugar control in patients with type 1 diabetes who switched from multiple daily insulin injections.
Some background
Glycemic (blood sugar) control is important to manage type 1 diabetes. There are many strategies to maintain glycemic control. All involve administering treatments that regulate blood sugar, such as insulin. Many patients manage blood sugar levels by administering multiple daily injections (MDI) of insulin. Another strategy is insulin pump therapy. This involves implanting a device with a sensor under the skin that measures blood sugar regularly (continuous glucose monitoring or CGM). Insulin is then released from the device when required (continuous subcutaneous insulin injection or CSII).
Although insulin pump therapy with CGM has been shown to be effective, the effects of switching from multiple daily injections to this treatment strategy have not been investigated.
Methods & findings
75 people with type 1 diabetes were included in the trial. This study was a follow-up from a previous clinical trial where patients were already undergoing CGM. These patients were assigned to either continue MDI or begin CSII treatment. Follow-up assessments were performed at 6, 14 and 28 weeks.
The primary outcome of this study was the average time patients had a blood glucose range of 70-180 mg/dl. Patients in the CSII group had an average of 83 minutes additional time in this range compared to the MDI group. Greater improvements were observed in patients with worse baseline glycemic control. There was a greater improvement in average blood glucose levels in the CSII group but no change in HbA1c levels (blood glucose levels over 3 months).
Patients in the CSII group had more instances of CGM measured hypoglycemia (dangerously low blood sugar).
The bottom line
This study concluded that CSII effectively improved glycemic control in patients with type 1 diabetes who switched from MDI. Patients with poorer glycemic control at baseline saw the greatest improvements in blood glucose management. The study also determined that CSII may be associated with higher rates of hypoglycemia.
The fine print
The number of participants included in the trial was relatively small. Larger studies may be necessary.
What’s next?
Glycemic control is essential to manage type 1 diabetes. Please discuss this with your doctor if you have any concerns.
Published By :
The lancet. Diabetes & endocrinology
Date :
Jul 12, 2017
