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Insulin pump therapy offers ‘improved clinical outcomes’

By Jane Lewis
Insulin pump therapy in young patients with type 1 diabetes is superior to insulin injections in terms of the risk of diabetic ketoacidosis and severe hypoglycaemia, suggests new research in JAMA.

Speaking to Endocrinology Today, Associate Professor Neale Cohen, endocrinologist and Director of Clinical Diabetes at Baker Heart and Diabetes Institute, Melbourne, said pump therapy was popular for use in people with type 1 diabetes, particularly children. While it has proven useful in terms of glycaemic control, there has been some concern in the past about worsening the risk of ketoacidosis.

‘Previous studies investigating this issue have tended to be quite small and provide mixed results. The current study is large and robust, with a well-defined cohort and matching process, and is quite definitive,’ he said.

The European population-based observational study set out to directly compare pump therapy with injection therapy in young patients with type 1 diabetes of duration more than one year, measuring rates of severe hypoglycaemia and diabetic ketoacidosis during the most recent treatment year.

The study included 30,579 patients, 14,119 of whom were treated with insulin pump therapy (median duration, 3.7 years) and 16,460 of whom received multiple (≥4 day) insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Compared with injection therapy, pump therapy was shown to be associated with significantly lower rates of severe hypoglycaemia (9.55 vs 13.97 per 100 patient-years) and ketoacidosis (3.64 vs 4.26 per 100 patient-years), as well as lower HbA1c levels (8.04% vs 8.22%).

‘Results of this study provide further evidence that insulin pump therapy, which is a core element of artificial beta cell technology, is safe and effective, even in routine diabetes care for unselected patients at a population-based level,’ the authors stated.

Commenting on clinical implications, Associate Professor Cohen said the results ‘suggest that pumps are safe, and are less likely than multiple daily injections to cause the types of acute complications that we worry about in young patients with type 1 diabetes.’ 

‘This is a good safety indicator that we’re not doing any harm using pumps, and a strong indicator that there are some small benefits as well in terms of glycaemic control,’ he said.
JAMA 2017; 318: 1358-1366.

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