Insulin Pump Therapy Improves Glycemic Control in Type 1 Diabetes Patients
The initiation of insulin pump therapy, or continuous subcutaneous insulin infusion (CSII), in patients with type 1 diabetes is associated with an improved glycemic control over time in the glucose range of 70-180 mg/dL, according to a recent study. However, the therapy was also associated with an increase in biochemical hypoglycemia.
The benefits of initiating CSII among patients with type 1 diabetes using continuous glucose monitoring (CGM) are not currently known.
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From April 14, 2015, to May 5, 2016, the researchers assessed 75 adult patients with type 1 diabetes that had been part of the CGM group in the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) trial. Participants were randomly assigned to continue CGM plus MDI (n=38) or switch to CGM plus CSII (n=37) for 28 weeks.
The primary outcome was CGM-measured time in the glucose concentration range of 70-180 mg/dL.
A total of 35 participants (92%) in the CGM plus MDI group and 36 participants(97%) in the CGM plus CSII group had completed the study. Results indicated that the mean use of CGM had been 6.7 days per week in the CGM plus CSII group, compared with 6.9 days per week in the CGM plus MDI group. The researchers noted that no participants in the CGM plus CSII group who completed the study had discontinued CSII. In the glucose concentration range of 70-180 mg/dL, mean time throughout follow-up had been 791 min per day in the CGM plus CSII group vs 741 min per day in the CGM plus MDI group.
Ultimately, the researchers found that participants in the CGM plus CSII group had demonstrated a greater decrease in CGM-measured mean glucose and hyperglycemia compared with participants in the CGM plus CSII group. However, they also noted an increase in CGM-measured hypoglycemia among participants on CGM plus CSII. From baseline to 28 weeks, mean HbA1c change was 0.3% in the CGM plus CSII group vs 0.1% in the CGM plus MDI group.
A total of 1 participant in the in the CGM plus MDI group and 1 participant in the CGM plus CSII group experienced severe hypoglycemia. Additionally, 1 participant in the CGM plus CSII group experienced diabetic ketoacidosis.
“Our findings show that glycemic control measured by time in the glucose range of 70-180 mg/dL (3.9–10.0 mmol/L) is improved by initiation of CSII in adults with type 1 diabetes,” the researchers concluded. “However, biochemical hypoglycemia also was increased in the study, which will be important to consider when incorporating these results into clinical practice.”
—Christina Vogt
Reference:
Beck RW, Riddlesworth TD, Ruedy KJ, et al. Effect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial. The Lancet Diabetes Endocrinol. 2017;5(9):700-708. http://dx.doi.org/10.1016/S2213-8587(17)30217-6.