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    Study: Insulin Pump Better Than Injections

    Researchers Say 'Artificial Pancreas' for Type 1 Diabetes May Be Reality in Several Years

    Insulin Pump-Sensor Improved Diabetes Control continued...

    The study included 485 people with type 1 diabetes, ranging in age from 7 to 70, who had been unable to achieve optimal blood sugar control with insulin injections.

    Half the patients received standard treatment, which involved testing their blood sugars throughout the day and taking insulin injections when needed. The other half used the pump and glucose sensor device, which delivered insulin through a small catheter inserted under the skin.

    The sensor was added only after the patients had become comfortable with the pump, usually after two to five weeks. Patients in both treatment groups also received training to help them better manage their diabetes.

    Hemoglobin A1c was monitored to assess blood sugar control. Normal hemoglobin A1c in people without diabetes ranges from 4% to 6%, and the goal for avoiding complications in people with the disease is less than 7%.

    After one year of treatment, patients in the pump group had significantly lower hemoglobin A1c levels than those in the insulin injection group. A1c levels in pump patients dropped from an average of 8.3% to 7.5%, while levels dropped to just 8.1% in the insulin injection group.

    Adults who used the pump had better outcomes than children and teens, but they were also more likely to use the devices for longer periods.

    And even though the pump patients achieved better blood sugar control, the incidence of severe low blood sugar was similar for both groups.

    The study appears in the July 22 issue of the New England Journal of Medicine. It was funded by Medtronic.

    Motivated Patients Had Best Outcomes

    Highly motivated study participants achieved the best blood sugar control.

    Patients who used the pumps 80% of the time reduced their risk of developing diabetes complications by 30% to 40%, Bergenstal says.

    In an editorial accompanying the study, endocrinologist Howard A. Wolpert, MD, of Boston's Joslin Diabetes Center questioned whether the devices would work as well in the general practice setting.

    "The expert training and guidance received by patients in clinical trials cannot be readily duplicated in a busy clinical practice," he writes.

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