Nov. 5, 1999 (Tuscaloosa, Ala.) -- Teen-age diabetics who use insulin pumps were able to reduce their risk of severe low blood sugar by 50% while maintaining better control of their diabetes than youths on multiple daily injections (MDI) of insulin, according to a study in the November journal Diabetes Care.
Insulin pumps are worn next to the skin, and deliver a programmable dose of fast-acting insulin through a small plastic tube, or catheter, which is placed just under the skin. In addition, extra insulin can be given based on blood sugar level results. They are about the size of a pack of cards and are battery-powered. Newer pumps are easy to use and reliable, allow better control of blood sugar, and remove much of the hassle associated with multiple insulin injections.
"The young people in our study who chose to go on insulin pump therapy achieved and maintained nearly normal [blood sugar] control and had 50% fewer severe hypoglycemic [low blood sugar] episodes than a group of similar adolescents using MDI," lead researcher Elizabeth A. Boland, a diabetes educator at Yale University School of Medicine, tells WebMD.
The study involved 75 youngsters on insulin pumps, ages 12-20, from the Yale Children's Diabetes Clinic, who completed the 12-month study. Fifty volunteers used MDI. All participants received intensive educational and motivational guidance on monitoring and controlling their diabetes.
HbA1C levels indicate how well the blood sugar has been controlled over the past several weeks. Lower levels indicate improved control. Average HbA1C levels in the insulin pump group decreased from 8.4% at the beginning of the study to 7.5%at the end of 12 months, a significant drop. Boland says the youngsters on pump therapy also needed "significantly less insulin" than those using MDI.
"These results show that pump therapy is a much more attractive alternative than MDI for the intensive management of type 1 diabetes," says Boland.
Philip Levy, MD, agrees. He says insulin pumping is enjoying new popularity among adults and adolescents alike. Reasons for that popularity, he believes, include the publicity given the technique by Nicole Johnson, the 1999 winner of the Miss America contest, and the fact that insulin infusion pumps have become smaller and easier to use. Levy is a clinical professor of medicine at the University of Arizona School of Medicine in Tucson and chairman of the endocrinology department at Good Samaritan Hospital in Phoenix.
"The youths on pump therapy loved their new regimen," says Boland. "They told me they felt that the 'diabetes clock' had been taken away -- that they had been freed from the tyranny of having to take multiple injections and freed from the necessity of awakening early to take morning insulin and then having to eat."
Overall, the youngsters using pump therapy "found coping with diabetes to be less difficult" than a similar group of young people on multiple injections, says Boland.
"This is an important study for diabeteologists, their young patients, and the parents of those patients -- for anyone who has faced the challenge of how to help young people improve their blood glucose control," Levy, an endocrinologist who treats a large number of pump users, tells WebMD.
"Both parents and physicians had feared that adolescents couldn't handle insulin pumping -- that they would experience frequent episodes of severe hypoglycemia. This study should calm those fears," says Levy.
"The message of the study is that with appropriate diabetes education, self-management training, and educational support, young people can be motivated to use insulin pumps to maintain nearly normal [blood sugar] levels with much fewer episodes of hypoglycemia than what we used to expect during intensive diabetes management," says Levy.