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Insulin Pump vs. Insulin Injection: Which Is Best for Type 1 Children?

Insulin pumps therapy is associated with better glycemic control and fewer complications, new study suggests.

Insulin delivery via injection and continuous subcutaneous insulin infusion via insulin pump were compared in a recent observational study to determine whether the rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in young adults with type 1 diabetes. The study population included 30,579 patients younger than 20 years with type 1 diabetes duration of more than one year and who have been treated with either insulin pump therapy or with multiple daily (≥4) insulin injections for at least one year.

Researchers examined data of 30,579 participants with mean age of 14.1 years, in which 14,119 patients used insulin pump therapy (median duration, 3.7 years) and the other 16,460 patients used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9,814 patients using injection therapy. The study findings show that patients were less likely to develop severe low blood sugar (difference, −4.42 [95% CI, −6.15 to −2.69]; P < .001) or diabetic ketoacidosis (difference, −0.63 [95% CI, −1.24 to −0.02]; P = .04) when using an insulin pump instead of insulin injections. The glycated hemoglobin levels were also lower in young people who used insulin pump (8.04%) than in those who injected insulin (8.22%); (difference, −0.18 [95% CI, −0.22 to −0.13], P < .001). Total daily insulin doses were also lower with an insulin pump therapy (0.84 U/kg) than with injections therapy (0.98 U/kg); (difference, −0.14 [−0.15 to −0.13], P < .001). There was no significant difference in body mass index between pump therapy and injection therapy groups.

These data support the use of insulin pumps in the young patient population with type 1 diabetes, and suggest that glycemic control may be improved without increasing the risks of low blood glucose or a life-threatening accumulation of acids in the blood when glucose levels increase. However, the study was not designed as a controlled study to prove that insulin pumps are better than injections, and parents or caregivers should not feel obligated to switch to pump therapy. Patients will have more intensive training with pump therapy than they do with injections. Insulin pumps therapy may not be the best option, particularly if insulin dose is missed; however, pumps work very well in selected people with proper support. The effectiveness of insulin depends on how well patients work to get the right dose at the right time, said Dr. Edwin Gale, an emeritus professor at the University of Bristol in the U.K. “Pumps may deliver insulin more consistently than injections by infusing it slowly and pumps can also be easier to adjust,” said Dr. Simon Heller, a diabetes researcher at the University of Sheffield in the U.K. “I think pumps should be offered widely to young children and people who experience hypoglycemia on insulin therapy,” Dr. Heller also added.

Since this study was not a controlled study, it was not fully proven that insulin pump therapy was better than injection therapy. Another limitation is that the researchers did not provide data on the type and amount of diabetes education on using pump therapy. Overall, these findings in the study provide evidence for improved glycemic control with insulin pump therapy compared with injection therapy in young adults with type 1 diabetes.

Practice Pearls:

  • The rates of severe hypoglycemia and diabetic ketoacidosis decrease with insulin pump therapy than with insulin injection therapy in young patients with type 1 diabetes.
  • The glycated hemoglobin levels and total daily insulin doses were also lower in children who used insulin pump than in children who injected insulin.
  • Effectiveness of insulin pump therapy depends on the patient following the treatment plan and training.

References:

Beate Karges, Anke Schwandt, Bettina Heidtmann. Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes. The JAMA Network. 2017 October 10.

 

Kay Lynn Tran, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy