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Potential Benefit With Sensor-Augmented Insulin Pump Therapy

Findings suggest treatment may reduce urine albumin creatinine ratio in T1DM.

The correlation between persisting albuminuria due to the effects of glycemic control remains unclear. It is believed that insulin delivery and glucose variability may be important factors to consider regarding this topic. For that reason, researchers set out to investigate the effect of 1-year treatment with sensor-augmented insulin pump (SAP) or multiple daily injections (MDI) on albuminuria.

Researcher Signe Rosenlund, MD, of the Steno Diabetes Center in Gentofte, Denmark, and colleagues analyzed 55 adults with T1DM and history of albuminuria on stable renin-angiotensin system (RAS) inhibition. These participants were randomly assigned to SAP (n=26), or MDI (n=29) and followed up for 1 year to identify the effect of each treatment on albuminuria.

Investigators found the SAP group to display a mean urine albumin creatinine ratio of -13% vs. 30% in the MDI group (unadjusted P=0.0151; adjusted for HbA1c at all visits, P=0.04; adjusted for HbA1c, sex, and BMI, P=0.02). HbA1c decreased by 1.3% in SAP group vs. 0.6% in the MDI group (P=0.01). The glucose variability in SAP group had decreases of 16mg/L.(0.9 mmol/L vs. 0.3 mmol/L ) in the MDI group (P=0.049). There were no significant differences for blood pressure in either group.

Authors believe this is the largest RCT comparing sensor-augmented insulin pump therapy with multiple daily injection treatment on late diabetic complications. Authors claim that sensor-augmented insulin pump therapy reduces urine albumin creatinine ration in T1DM patients with a history of albuminuria on stable RAS inhibition. It is important to note this significance was achieved after adjustment. Furthermore, SAP therapy reduces glucose variability and HbA1c, which may also benefit diabetic nephropathy.

Practice Pearls:

  • Sensor-augmented insulin pump therapy reduces urine albumin creatinine ratio in T1DM patients with a history of albuminuria on stable RAS inhibition.
  • Treatment with sensor-augmented insulin pump reduced glucose variability and HbA1c.
  • There may be potential benefits of sensor-augmented insulin pump therapy on diabetic nephropathy.

Rosenlund, Signe, et al. “Effect of sensor-augmented pump treatment vs. multiple daily injections on albuminuria: a 1 year randomized study.” The Journal of Clinical Endocrinology & Metabolism (September 21, 2015): jc-2015-2839.