Insulin pump didn't improve glycemic control compared to training on injections
British patients with type 1 diabetes were enrolled in group training courses that taught flexible intensive insulin treatment and then randomized to an insulin pump or multiple daily injections and followed for two years.
Patients with type 1 diabetes who received an insulin pump had similar improvements in glycemic control as patients who simply received education about giving themselves multiple daily injections, a recent study found.
The trial included 260 patients from eight secondary care centers in England and Scotland. They all had type 1 diabetes and were willing to undertake intensive insulin treatment, and most (n=235) had a baseline HbA1c of 7.5% or higher. They were enrolled in group training courses that taught flexible intensive insulin treatment and then randomized to a pump or multiple daily injections and followed for two years. Results were published by The BMJ on March 30.
Both groups showed significant improvements in glycemic control. After two years, the mean change in HbA1c was −0.85% in the pump group and −0.42% in the injection group. After adjustment, the pump group showed a greater decline in HbA1c, but the difference was not significant (−0.24%; 95% CI, −0.53 to 0.05). Rates of severe hypoglycemia also declined similarly in both groups. Both groups showed improvement on psychosocial measures, but pump users had greater improvement in treatment satisfaction and in some quality of life measures (dietary freedom and daily hassle) at 12 and 24 months.
Although participants in the trial “achieved a clinically worthwhile decrease in HbA1c,” the study authors concluded that adding pump treatment to the structured training did not substantially enhance educational benefits on glycemic control, hypoglycemia, or psychosocial outcomes. They noted that none of the study participants had expressed a particular desire to use an insulin pump, which could have affected the results. However, the findings support a policy of not routinely providing insulin pumps to patients with poor glycemic control until after giving them self-management training and observing the effects, the authors said.
“Those who find that despite their best efforts, injections fail to deliver the expected benefits could then be offered the additional technological advantages of an insulin pump,” they wrote. Another significant result of the study was the generally high HbA1c levels of British patients eligible for the trial, which reveals the urgent need to explore barriers to successful self-management of type 1 diabetes, the authors said.