Insulin Pumps Work for Type 2 Diabetes

Blood Sugar Control as Good as Injections, but Patients Like Insulin Pumps Better

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Aug. 26, 2003 -- Available for more than two decades, insulin pumps have replaced daily injections for many patients with type 1 diabetes. Now, new research shows them to be a safe and effective option for those with insulin-dependent type 2 diabetes.

In the first long-term study comparing the efficacy and safety of insulin pumps to multiple daily shots in people with type 2 diabetes, insulin pumps were found to be equal to injections for lowering average blood sugar levels. While many people with type 2 diabetes can control their disease though lifestyle changes or oral medications, at some point they may require insulin to keep their blood sugar levels under control.

Insulin pumps are worn next to the skin and deliver a programmable, continuous flow of insulin. About the size of a pager, the pumps are worn both day and night.

Patients Prefer Insulin Pumps

In the newly reported study conducted at multiple centers, 132 people with type 2 diabetes over the age of 34 were randomly selected to receive insulin for six months, either continuously by an insulin pump or by multiple daily injections. Three months into the study, both groups had similar improvements in blood sugar levels. But roughly nine out of 10 patients on the insulin pump preferred it to taking daily injections, citing convenience, ease of use, and flexibility as reasons. Side effects such as low sugars or hypoglycemia were similar in the two groups. The findings are reported in the September issue of the American Diabetes Association publication Diabetes Care.

Lead researcher Philip Raskin, MD, of the University of Texas Southwest Medical Center in Dallas, says he believes a slight advantage in treatment outcome would have been seen in those on the insulin pump if the study had been done at one treatment center instead of multiple centers. Raskin is a consultant for the insulin pump maker Novo Nordisk Pharmaceuticals, which funded the study.

"My view is that there is probably a small advantage, in terms of control, in using a pump over multiple daily injections," he tells WebMD. "Certainly, our patients liked it better."

The American Diabetes Association (ADA) is funding a larger, multiple-center trial testing insulin pumps in people with type 2 diabetes over the age of 60. The study will include cost-effectiveness analysis, and, if favorable, may result in insulin pump therapy being covered by Medicare for some patients. Results from the trial are expected sometime next year.

Insulin Pumps Not for Everyone

ADA spokesman Nathaniel Clark, MD, says insulin pump manufacturers have a strong economic incentive for promoting the delivery system for people with type 2 diabetes since 90% to 95% of diabetic people fall into this category. But he adds that insulin pumps may very well help some type 2 patients manage their diabetes better.

"There are people with type 2 diabetes who, despite multiple daily insulin injections, have problems with unexplained [low blood sugar]," he says. "In these patients, I can see a use for delivering a predictable amount of insulin with a pump. Pumps may have a legitimate place in the treatment of these selected patients. But they are not the be-all and end-all for type 1 diabetes, and they are even less so for type 2 patients."

Both experts agree that patients should not switch from shots to a pump simply because they view it as an easier treatment option.

"Being on the pump requires a lot of work," Raskin says. "You still have to watch what you eat. You have to monitor your blood glucose levels several times a day. Just because you're not taking shots doesn't mean you can forget you have diabetes."

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SOURCES: Diabetes Care, September 2003. Philip Raskin, MD, professor of medicine, University of Texas Southwestern Medical Center, Dallas. Nathaniel Clark, MD, national vice president for clinical affairs, American Diabetes Association.
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