Issue 164 Item 5 Insulin Pump Therapy Lowers HbA1c Than More Insulin Glargine

Pump users lowered A1c levels to 7.2% from 8.1% and the MDI group dropped o 8.1% from 8.4%.

In a study of young type 1 diabetics, continuous subcutaneous insulin infusion (CSII) with insulin aspart was more effective in lowering HbA1c levels than multiple daily insulin (MDI) injections with insulin glargine and pre-meal insulin aspart. Moreover, patients preferred CSII.

Elizabeth Boland, a nurse practitioner on the Yale Pediatric Diabetes Team, presented her group’s findings during the American Diabetes Association’s 63rd Annual Meeting in New Orleans. Most previous studies of CSII in children were retrospective and lacked randomized comparisons with MDI, according to Boland and colleagues.

In an ongoing randomized, prospective study, they are comparing the use of pump therapy with insulin aspart versus multiple injections (4 per day) consisting of insulin glargine (once-daily) and insulin aspart taken at meals and snacks in 30 patients with type 1 diabetes 8 to 19 years of age.

"Our preliminary findings [in 26 children] showed that pump therapy was more effective in controlling blood sugar, as measured by HbA1c, than the multiple injection regimen," Boland said. At 4 months, pump users significantly lowered their HbA1c levels to 7.2% from 8.1% at baseline. In contrast, HbA1c in the MDI group showed no significant change from baseline, dropping only to 8.1% from 8.4%.

Pump users but not glargine users significantly reduced their required total daily dose of insulin.

There were 4 episodes of severe hypoglycemia in the MDI group and 2 in the pump group, but no diabetic ketoacidosis in either group.
After 4 months, all 12 children in the pump group chose to continue on CSII therapy and 12 of the 14 children in the MDI group opted to switch to CSII. American Diabetes Association’s 63rd Annual Meeting