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Insulin Pump Therapy Beneficial in Some Patients with Poorly Controlled Type 2 Diabetes

A new study finds that insulin-pump treatment can be effective for patients with type 2 diabetes who have not achieved optimal glycemic control from multiple daily injections…. 

Many patients living with type 2 diabetes are unable to meet their A1C targets despite multiple daily insulin injections. Results of the OPT2MISE trial were recently released. The trial was a randomized, open-label multi-center, controlled trial comprised of patients from 36 hospitals and other care centers throughout Canada, Europe, Israel, South Africa and the United States. Patients with type 2 diabetes who had poor glycemic control despite multiple daily injections were eligible for the study.

A total of 495 patients were enrolled into a 2 month dose-optimization trial period. After this period of time, patients with an A1C remaining between 8.0-12.0% were randomly assigned (1:1) to pump treatment or continuation of multiple daily injections. Neither patient nor investigators were masked to treatment selection. The primary endpoint was change in mean A1C from baseline to the end of the study period based on an intention to treat population.

Out of those patients eligible for the study, 331 were randomized: 168 to pump treatment and 163 continued with multiple daily injections. Mean A1C at baseline was 9% for both groups. At 6 months, mean A1C had decreased by 1.1% in the group undergoing pump treatment and 0.4% in those doing multiple daily injections. The proportion of patients with A1C levels of 8% or less was nearly twice as high with the pump; 55% versus 28% with the multiple daily injections. At the conclusion of the study, the mean total daily dose of insulin was 97 units with pump treatment versus 122 units for multiple daily injections.

Two serious adverse events related to diabetes occurred with the pump group resulting in hospital admission compared with one in the multiple daily injection group.

Dr. Pratik Choudhary, senior lecturer and consultant in diabetes at King’s College London, United Kingdom, writes, "OPT2MISE provides a compelling case for the clinical effectiveness of insulin-pump treatment in type 2 diabetes, suggesting that it can help improve glycemic control in this difficult-to-treat group of patients who are unable to achieve glucose control despite increasing doses of insulin."

Dr. Yeves Reznik, head of the endocrinology and diabetology department at the University of Caen Cote de Nacre Regional Hospital Center, France, who published the trials underscored the importance of decreasing a patient’s A1C. He states, "With a 1.1% reduction in A1C, up to a 40% microvascular risk reduction could be expected, without risk of severe hypoglycemia."

Practice Pearls:

  • Many patients living with type 2 diabetes are unable to meet their A1C targets despite multiple daily insulin injections
  • At the conclusion of the study, the mean total daily dose of insulin was 97 units with pump treatment versus 122 units for multiple daily injections.
  • With a 1.1% reduction in A1C, up to a 40% microvascular risk reduction could be expected

Reznik MD, Yves, Cohen MD, Ohad, Aronson MD, Ronnie, et al. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomized open-label controlled trial. The Lancet, Early Online Publication. July 3, 2014.