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 In type 1 diabetes, a lifelong condition, the pancreas produces
little or no insulin, a hormone needed to allow blood sugar to enter
cells and produce energy. People with the condition usually have to
test their own blood sugar level throughout the day and inject
insulin to manage it; otherwise they risk complications like heart
disease and kidney damage.
Some previous research has suggested pumps may help patients get
better blood sugar control than they can achieve by giving
themselves multiple daily insulin injections. But patients tend to
get more intensive training on managing their blood sugar with pumps
than they do with injections, so some doctors have questioned
whether better patient education might be the reason pumps get
better results.
For the current study, researchers set out to answer this question.
They offered 260 adults with type 1 diabetes the same education on
how to manage their blood sugar, also known as blood glucose, and
then randomly assigned participants to use pumps or daily
injections.
"What the trial shows fairly unequivocally is that
education/training can produce considerable benefit, although it
leaves many patients still a long way from current glucose targets,"
said lead study investigator Dr. Simon Heller, a diabetes researcher
at the University of Sheffield in the UK.
To compare pumps to injections, researchers examined average blood
sugar levels over the course of several months by measuring changes
to the hemoglobin molecule in red blood cells. The hemoglobin A1c
test measures the percentage of hemoglobin that is coated with
sugar, with readings of 6.5 percent or above signaling diabetes.
At the start of the study, participants had average A1c readings of
9.1 percent, indicating poorly controlled blood sugar with an
increased risk of serious complications.
After two years of follow-up, most patients still had poorly
controlled blood sugar. People using the pumps achieved average A1c
reductions of 0.85 percentage points, compared with 0.42 percentage
points with multiple daily injections, researchers report in the BMJ.
Once researchers accounted for other factors that can influence
blood sugar such as age, sex and treatment center, the difference in
A1c for pump versus injection patients was too small to rule out the
possibility that it was due to chance.
There are many different types of pumps and injection devices on the
market, and one limitation of the study is that researchers didn't
examine how specific design features might influence how well
patients succeeded in managing their blood sugar, the authors note.
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It's also possible that the effort to give pump and injection
patients the same level of education may have skewed the results
because in real life, patients might get more education when they
start using pumps than they would for injections, said Dr. Roman
Hovorka, director of research at the University of Cambridge
Metabolic Research Laboratories in the UK.
Pumps also have a technological advantage that wasn't addressed in
the study, Hovorka, who wasn't involved in the research, said by
email. These devices can collect data on insulin delivery and blood
sugar levels and transmit that information to clinicians, enabling
doctors to adjust treatment based on the results.
But because pumps are much more expensive than injections, it
doesn't make sense to use them unless they have a proven advantage
for blood sugar control, said Dr. Edwin Gale, emeritus professor of
diabetes at the University of Bristol in the UK.
In the UK, pumps cost about 2,500 pounds ($3,116.25) a year plus an
additional 1,500 pounds ($1,869.75) for batteries and other
supplies, researchers note.
"I think the take-home message for patients is that pumps won't do
the job for you," Gale said by email. "They are not for everyone,
and many people can do just as well on multiple injections."
SOURCE: http://bit.ly/2nI6wP9 The BMJ, online March 30, 2017.
($1 = 0.8022 pounds)
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