Pump, Real-Time Monitor Best in Type 1 Diabetes
For type 1 diabetics, sensor-augmented pump therapy offers better control of blood glucose than the traditional method of fingersticks and insulin injections, researchers found.
Patients on this type of pump therapy, which involves real-time continuous glucose monitoring (CGM) plus continuous insulin infusion (CSII), lowered their hemoglobin A1c (HbA1c) far more than those who did standard monitoring plus injections (-0.68%, 95% CI -0.81% to -0.54%), Sherita Hill Golden, MD, of Johns Hopkins University, and colleagues reported online in the Annals of Internal Medicine.
Remove the CGM, however, and there was little difference between the insulin pump and multiple shots of insulin each day, the researchers said.
"The addition of this monitoring method to [standard monitoring] and intensive insulin therapy can assist in achieving glycemic targets in type 1 diabetes," they wrote.
Advances such as CGM and insulin pumps have come about to improve blood glucose control and quality of life for diabetes patients, but there's a lack of comparative data as to which methods offer the biggest advantages.
So Hill Golden and colleagues conducted a review of 33 randomized, controlled trials of the various therapies.
They found that the traditional method of multiple daily injections and the newer continuous insulin infusion pumps were similar in terms of their effects on HbA1c and hypoglycemia for adult and pediatric patients with either type 1 or type 2 diabetes.
Adults with type 1 diabetes appeared to have better glucose control with the pump (-0.30%, 95% CI -0.58 to -0.02%), but these results were heavily influenced by just one study, the researchers cautioned.
They also found that patients with type 1 disease who used CGM achieved lower HbA1c levels more often than those who used standard fingerstick monitoring (-0.26%, 95% CI -0.33% to -0.19%), without any difference in severe hypoglycemia.
But sensor-augmented pump therapy offered the clearest advantages, the researchers said, reducing HbA1c levels significantly more than multiple daily injections plus standard blood glucose monitoring in type 1 diabetes (-0.68%, 95% CI -0.81% to -0.54%).
They noted, however, that there was little evidence available for assessing other outcomes, including severe hypoglycemia or quality of life, between sensor-augmented pump therapy and the most traditional method.
Overall, the researchers added, children with type 1 disease were more satisfied with their therapy if they were on the pump than on standard monitoring and injections, and adults with type 1 disease had better diabetes-specific quality of life with the pump.
These data "suggest that the approach to intensive insulin therapy can be individualized to patient preference that will maximize their treatment satisfaction and quality of life," they wrote.
Hill Golden and colleagues warned that the analysis was limited by the fact that many of the included studies were small, of short duration, and limited to white patients with type 1 disease, which may restrict generalizability.
They said future research should include larger studies among subpopulations for whom diabetes incidence is growing, such as the elderly, minorities, and those who use insulin to treat type 2 disease.