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Tuesday 9 June 2015

Insulin Pumps Disappoint in Real World Practice

Nearly 40% of adult users at one tertiary care center averaged over 8.5% HbA1c.

BOSTON -- Insulin pumps may improve but often don't control glycemic levels in type 1 diabetes, a retrospective U.K. study showed.

Fully 38% of patients maintained a hemoglobin A1c over 8.5% on continuous subcutaneous insulin infusion and 11% were over 10% A1c, Lalantha Leelarathna, MBBS, PhD, of the University of Manchester, England, and colleagues found.

That was despite an average 0.6% A1c improvement after staring pump therapy, with greater declines in patients starting at higher levels, they reported here at the American Diabetes Association meeting.

To see such high rates of uncontrolled HbA1c levels in adults was surprising, commentedClifford J. Bailey, PhD, of Aston University in Birmingham, England.

"I would have expected only a few patients to be over 8.5% unless they were adolescents," he told MedPage Today.

Leelarathna agreed and suggested that adherence might have been one explanation and that limited use with continuous glucose monitoring, which is not routinely funded in the U.K. national healthcare system, in the cohort could have been another factor.

"Management of type 1 diabetes is still very challenging," he told MedPage Today. "Even with pump therapy many patients don't achieve targets. This is real life."

"You always hope the pump will improve glycemic control, but it depends on whether the patient does the necessary things," commented Cynthia Young, RN, of Maine Medical Center in Portland, Maine.

"A pump is only as smart as the user," agreed Erica Page, RN, CDE, of Mercy Hospital also in Portland, Maine.

The study included all 442 patients on a pump for at least 12 months at a single tertiary care center and with glycated hemoglobin averaged over a 30 month period through November 2014.

The cohort ranged in age from 31 to 50 and a median 20 years of experience with the disease at initiation of pump therapy.

Age, duration of diabetes, and length of follow-up were not significant factors in change in glycemic control after getting the insulin pump.

Overall, the proportion of patients in control of their diabetes with an A1c under 7.5% improved from 19% before getting the insulin pump to 32% afterward, while the proportion in the over 8.5% HbA1c group declined from 52% to 40%.

The brand of pump also was not significantly linked to improvement, although traditional pumps were more often associated with at least 0.5% improvement in A1c compared with the patch-style OmniPod.

Limitations included the retrospective single-center design, lack of data on hypoglycemia, and possible selection bias.

Generalizability to other practice settings, like U.S. centers, wasn't clear, Leelarathna cautioned.

"Use of pumps is less than in the U.S.," Bailey noted. "It is reserved for more difficult to treat individuals, usually ones that are uncontrolled in both directions [hypoglycemia and hyperglycemia], but our major concern is to avoid severe hypos."

Could it be they were just following diet guidelines from a BDA dietitian?



Unknown said...

Open your eyes guys, the secret to diabetes is in our faces! Without relying on bullcrap meds that just treat it, is in their diet and lifestyle. Luckily I was able to beat my own Type 2 Diabetes when I figured out that metformin was ineffective, my doctor wasn't much help compared to natural cures available to me. Natural cures are effective, safe, and largely FREE or EXTREMELY cheap. Why are people NEGLECTING TO RESEARCH THEM?

It's kind of hard for me to explain the method I used, but the way to beat diabetes naturally is covered extremely well in the Diabetes Destroyed book (It's better explained here: ). Essentially, the book guided me towards improvements in my health that were so easy to understand that I read it from cover to cover in the same night I discovered it. Today, a few months later, I've dropped 30 pounds. My blood sugar is down from 140 to 70-80 (fasted). I feel better than ever and I'm never going to have to deal with insulin injections. It did more for me than Metformin and the ADA diet ever could.

Lowcarb team member said...

Thanks for your comment Arch Ange.

We have been following a LowCarb diet for the past seven years which we consider to be a natural way of controlling our T2 without the need for excessive medication.