Issue 127 Item 2 Using Insulin Pumps at Time of Diagnosis for Type 1 Diabetes

A study, presented by Dr. Paolo Pozzilli of the Bio-Medical University Campus in Rome, suggests that an insulin pump may be the best way to control diabetes from the start. In a prospective, randomized trial sponsored by makers of Medtronic/MiniMed insulin pumps, 23 patients aged 8-32 years were placed on insulin pumps at the time of diagnosis of type 1 diabetes. Of those, 12 were subsequently taken off the pump and randomized to intensive insulin therapy, consisting of three premeal injections of rapid-acting insulin and one shot of NPH insulin at bedtime.

Both groups also received daily doses of nicotinamide, which has been shown to preserve -cell function.

Over 2 years of follow-up, the pump group received consistently more insulin than did those taking multiple injections (0.62 vs. 0.44 IU/kg), but did not have higher rates of hypoglycemia. Hemoglobin A1c values were similarly good in both groups (less than 7.0%), and body weights were not different between the two groups, despite the higher insulin doses with the pump.

Insulin doses in the pump patients were consistently higher at all times of the day and at night, compared with doses in the injection group.

It appears that the pump more accurately meets the patient’s immediate insulin needs, especially during the night, he remarked.

At 24 months, C-peptide secretion was 38% higher than baseline in the pump patients, compared with an increase of just 27% in the multiple injection group, suggesting that the pump provided better protection of residual -cell function and increased endogenous insulin secretion. Such protection essentially buys time for the patient, thereby providing greater protection against later diabetes complications, Dr. Pozzilli said.

All seven patients were happy with the pump. They found it easy to use and continued using it even after completion of the trial, he noted. Presented at scientific sessions of the ADA