Insulin Pump Beats Shots for Young Diabetics

From Reuters Health:

NEW YORK - Continuous insulin infusion delivered by a portable pump is more effective than multiple daily injections of insulin in controlling blood sugar levels in young people with type 1 diabetes, according to a new study.

Moreover, most patients chose to continue with or switch to insulin pumps after the study was over, Elizabeth A. Doyle and colleagues from the Yale University School of Medicine in New Haven report in the medical journal Diabetes Care.

The researchers randomly assigned 32 patients aged 8 to 21 to treatment with pump-delivered continuous subcutaneous insulin infusion (CSII) or to once-daily long-acting insulin (glargine) plus fast-acting insulin injections before meals and snacks, for 16 weeks.

Blood levels of hemoglobin A1c - an indicator of long-term blood glucose control - did not change in the multi-injection group, but dropped to target levels in the insulin pump patients.

The researchers point out that glargine cannot be mixed with rapid-acting insulin, so therapy with this insulin analog requires patients to give themselves injections with fast-acting insulin before meals and large snacks. The need for multiple daily injections can make compliance difficult, they add.

In fact, at the close of the study, 14 of the 16 patients on CSII chose to continue using the infusion pumps, while 12 of the 16 patients on multiple daily injections switched to CSII.

The team calls for further studies but concludes that "in the context of a short-term randomized clinical trial, we observed a considerably greater improvement in hemoglobin A1c levels with CSII than with glargine. It should be noted, however, that no single approach to treatment is ideal for every patient."

SOURCE: Diabetes Care, July 2004.