A new evidence review suggests that using a pump to deliver insulin
continuously, instead of taking three or more daily injections, might
result in better control of blood sugar for people with
type 1 diabetes.
"The findings of this review tell us that both continuous
subcutaneous insulin infusion and multiple injections correct blood
glucose levels. However, [continuous infusion] may be better for
reducing harmful fluctuations in blood glucose," said lead
author Marie Misso, Ph.D.
Type 1 diabetes, which used to be known as juvenile diabetes,
results when the pancreas is not able to secrete enough
insulin, causing the levels of glucose (or sugar) in the blood to rise.
Chronically high blood glucose can lead to heart attacks, circulation
problems and blindness. Low levels can lead to unconsciousness and even
death. Type 1 diabetes is one of the most common chronic diseases of
childhood.
Most people with the condition control their glucose by injecting
themselves with insulin three or more times per day. Others choose to
use a pump, which gives continual, smaller doses of insulin without the
discomfort of injections.
"There are numerous studies that evaluate these treatments, but
most are of poor quality," said Misso, a research fellow at the
Monash Institute of Health Services Research in Clayton, Australia. "So
there has been uncertainty about which treatment is best
for maintaining consistent levels of blood glucose and reducing harmful
fluctuations."
In the new review, Misso and colleagues analyzed the results of 23
studies that assigned 976 adults and children to one of the two
interventions randomly. Researchers looked at measures such as levels
of hemoglobin A1c (or HbA1c), a widely used marker for assessing
long-term glucose control. They also looked at the incidence of both
high and low blood glucose.
The review appears in the latest issue of The Cochrane Library, a
publication of the Cochrane Collaboration, an international
organization that evaluates medical research. Systematic reviews draw
evidence-based conclusions about medical practice after considering
both the content and quality of existing medical trials on a topic.
While participants using the insulin pump had significantly lower HbA1c
levels than those using multiple daily injections, no differences
existed between the two for non-severe low blood glucose levels.
However, there appeared to be a reduction in severe incidents of low
blood glucose among those using the pump.
"Good evidence is now available to support the use of
continuous subcutaneous insulin infusion in the appropriate patient. It
is essential to consider adverse events, late complications of
diabetes, mortality and cost when deciding whether [a pump] is
appropriate for the patient," Misso said.
For people who likely have to deal with their condition for the rest of
their lives, convenience is another consideration that comes into play.
The advantages of using the insulin pump include being able to avoid
possibly painful injections several times a day. In addition, pumps
administer the medication without the user having to find a private
place to give the injection.
The downside to pump use includes having to wear it like a pager or
cell phone throughout the day, concerns about protecting the tubing
that goes into the body, although wireless pumps have
recently come on the market, and worries about
breaking the pump during rough play or exposure to water.
Ramin Alemzadeh, M.D., director of the Diabetes Program at the
Children's Hospital of Wisconsin in Milwaukee, cautioned that
although the researchers reported pumps might improve glucose control
overall, pediatric patients should not expect major changes in the
longer-term control of blood glucose.
"In our experience, we don't see a significant overall
blood glucose improvement beyond six months or one year of treatment in
most children and adolescents. Initially, the patient's HbA1c
levels improve, but after a while levels begin to rise and are not
significantly different from where they started," Alemzadeh
said. "A patient's diabetes management starts with them
and their family. How well they do is independent of which method of
insulin administration they use."
The review discloses that one of the co-authors has received
compensation for lectures and advisory board participation from
companies who make insulin or insulin pumps. His department has also
received funding for research and educational activities from these
companies.
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FOR MORE INFORMATION:
Health Behavior News Service: Lisa Esposito, Editor, at (202) 387-2829
or www.hbns.org.
The Cochrane Collaboration is an international nonprofit, independent
organization that produces and disseminates systematic reviews of
health care interventions and promotes the search for evidence in the
form of clinical trials and other studies of interventions. Visit
http://www.cochrane.org for more information.
Misso ML, et al. Continuous subcutaneous insulin infusion (CSII) versus
multiple insulin injections for type 1 diabetes mellitus. Cochrane
Database of Systematic Reviews 2010, Issue 1.
© 2010 Center for Advancing
Health used by permission