Newer Technologies Work Better than Conventional Methods in Controlling Glucose

The research findings, suggest that even though these diabetic control technologies are more costly, people with diabetes who use an insulin pump are more satisfied with their treatment and quality of life than those who give themselves insulin shots many times a day.

The study's senior author, Sherita Hill Golden, M.D., M.H.S., an associate professor in the division of endocrinology and metabolism at the Johns Hopkins University School of Medicine, stated that, "Our study was designed to help patients and physicians better understand the effectiveness of insulin pumps and blood sugar sensors that provide constant glucose monitoring compared to conventional approaches." "We found that certain devices confer real benefits."

In their study, Golden and her colleagues reviewed and re-analyzed data from 33 randomized controlled trials that compared the newer technologies to conventional methods of monitoring and controlling blood sugar levels. The new technologies they looked at were primarily real-time continuous glucose monitoring devices and insulin pumps.

The continuous monitoring devices track blood sugar levels all day and night, as often as every five minutes, using a sensor that is attached to the abdomen with a small needle held in place by tape. The sensor sends the results to a display that is worn on the belt. Diabetic individuals can make decisions about adjusting insulin therapy and/or activity levels based on the readouts. Patients still need to prick their fingers two to four times a day to make sure the device is working properly, but that is down from as many as eight to 10 times a day for patients trying to strictly control blood sugar. These devices also sound alarms if the blood sugar level is dangerously high or low.

The researchers found that children, teens and adults with type 1 diabetes who used continuous monitoring had lower blood glucose levels than those who used finger stick testing alone. They also spent less overall time with too much blood sugar (hyperglycemia). Both methods worked equally well to control hypoglycemia, the condition that results when blood sugar levels are too low.

While there was little difference in blood sugar control in those who give themselves multiple insulin shots a day versus those who used insulin pumps, those with type 1 diabetes who used the sensor-augmented pumps, pumps that include real-time continuous glucose monitoring devices, did much better controlling blood sugar than those who used finger stick testing and shots.

Golden added that, "Those who use the devices as prescribed do the best at maintaining blood sugar control." "Adherence is the key to effectiveness."

Golden says that not all insurance companies cover the new technologies. Medicare, for example, doesn't cover the real-time continuous glucose monitoring sensors. Golden also says her study was unable to determine whether people over 65 benefit specifically from using the device.

Researchers say they still want to investigate how patients using these convenient technologies fare in the long term as compared to those who use older methods.

Annals of Internal Medicine, July 10, 2012