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 Type 1 diabetes is a lifelong condition that develops when 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.
Researchers examined data on 14,460 diabetes patients under 20 years
old who used insulin pumps and another 16,460 patients who injected
insulin. With pumps, patients were less likely to develop
dangerously low blood sugar or a life-threatening accumulation of
acids in the blood that happens when sugar levels get too high.
“The study adds to the growing evidence of the benefits of insulin
pump therapy, when applied appropriately, in the young,” said Dr.
Roman Hovorka of the University of Cambridge Metabolic Research
Laboratories in the U.K.
Previous research has suggested pumps may help young patients get
better blood sugar control than they can achieve by giving
themselves multiple daily insulin injections, Hovorka, who wasn’t
involved in the study, said by email. But research to date on how
well pumps work to prevent dangerously low blood sugar has yielded
mixed results, he said.
All of the patients in the current study had been using either
injected or pumped insulin for at least one year.
Overall, dangerously low blood sugar known as hypoglycemia happened
at a yearly rate of 9.55 out of every 100 kids treated with insulin
pumps, compared with almost 14 children out of every 100 treated
with injections, researchers report in JAMA.
Rates of ketoacidosis, a life-threatening buildup of acid in the
blood, were 3.64 patients out of every 100 treated each year with
insulin pumps, compared with 4.26 kids out of every 100 per year
treated with injections.
The study also looked at one measure of blood sugar known as
glycated hemoglobin, which assesses average blood sugar levels over
the previous several months. Higher numbers indicate poorer blood
sugar control over time.
Glycated hemoglobin was 8.04 percent for kids who used pumps and
8.22 percent for children who injected insulin, the study found.
Total daily insulin doses were also lower with a pump than with
injections.
The study wasn’t a controlled experiment designed to prove that
insulin pumps are better than injections, however.
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Another limitation is that researchers lacked data on the type and
amount of diabetes education on using insulin that children and
parents received, Dr. Beate Karges, of RWTH Aachen University in
Germany and colleagues write. Karges didn’t respond to requests for
comment.
Patients tend to get more intensive training on managing their blood
sugar with pumps than they do with injections, and some doctors have
questioned whether better patient education might be the reason
pumps get better results.
Pumps may deliver insulin more consistently than injections by
infusing it slowly, and pumps can also be easier to adjust, said Dr.
Simon Heller, a diabetes researcher at the University of Sheffield
in the U.K. who wasn’t involved in the study.
“They are not always more comfortable or convenient,” Heller said by
email. The best option may depend in part on children’s age.
“I think pumps should be offered widely to young children and people
who experience hypoglycemia on insulin therapy,” Heller said. “For
adolescents, particularly those who find it difficult to do all the
complicated things in managing diabetes, pumps may not be the best
option, particularly if insulin is missed.”
However it’s delivered, the effectiveness of insulin depends on how
well patients work to get the right dose at the right time, said
Edwin Gale, an emeritus professor at the University of Bristol in
the U.K.
“Pumps work very well in selected people with proper support, but
they are not for everyone,” Gale, who wasn’t involved in the study,
said by email. “There is nothing in this study to say that parents
should feel obligated to opt for pump therapy.”
SOURCE: http://bit.ly/2yDkAAf JAMA, online October 10, 2017.
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