Insulin Pumps Better Than Shots for Diabetes Control

Insulin pumps provide better blood sugar control for adults with diabetes than multiple daily insulin injections, a new study says.

Insulin pumps are small devices that are worn by patients and deliver constant amounts of insulin to the body through a catheter placed under the skin.

The multicenter, international study was funded by medical device maker Medtronic and included 331 people aged 30 to 75. All of the patients had poorly controlled type 2 diabetes and were using multiple daily injections of insulin to control their blood sugar levels.

The patients were randomly assigned to either continue using injections or to switch to an insulin pump.

After six months, patients who used the insulin pumps had a much greater reduction in average blood sugar levels than those who used injections, the study found. According to the researchers, twice as many patients in the pump group reached the blood sugar control target range (55 percent vs. 28 percent).

By the end of the study, patients in the pump group required a 20 percent lower daily dose of insulin than those in the injection group. Patients in the pump group also averaged nearly three hours less per day with high blood sugar than those in the injection group, the team reported July 2 in The Lancet.

Insulin Pump Therapy
An insulin pump is a small mechanical device, a little larger than a pager that is worn outside the body, often on a belt or in a pocket. It delivers fast-acting insulin into the body via an infusion set - a thin plastic tube ending in a small, flexible plastic cannula or a very thin needle. You insert the cannula beneath the skin at the infusion site, usually in your abdomen or upper buttocks. You keep the infusion set in place for two to three days (sometimes more), and then move it to a new location. All insulin is delivered through the infusion set.

The insulin pump is not an artificial pancreas. Rather, it is computer-driven device that delivers fast-acting insulin (NovoLog, Humalog, or Apidra) in precise amounts at pre-programmed times. Wearing an insulin pump might require more work on your part than traditional injection therapy, especially if you are not used to checking your blood sugar several times a day. You must also learn to use the pump to deliver the extra insulin you require when you eat.

The following companies make or sell insulin pumps in the United States:

  Medtronic MiniMed
  OmniPod (Insulet)

Insulin Pumps Better Than Shots for Diabetes Control According to the study, the amount of time people spent with extremely low blood sugar remained similarly low in both the pump and injection groups.

“Our findings open up a valuable new treatment option for those individuals [who are] failing on current injection regimens,” study author Yves Reznik, from the University of Caen Cote de Nacre Regional Hospital Center in France, said in a journal news release. He believes that the devices “may also provide improved convenience, reducing the burden of dose tracking and scheduling, and decreasing insulin injection omissions.”

Two experts in the United States weren’t surprised by the findings.

“Many people with type 2 diabetes work hard to maximize the benefit of multiple daily injections of insulin but still struggle to keep their blood glucose values in target range,” said Virginia Peragallo-Dittko, executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola, N.Y.

She said the study “supports use of an insulin pump as another safe and effective treatment option for this particular group of patients without promoting weight gain or hypoglycemia.”

What Is An Insulin Pump?

When you have diabetes and rely on insulin to help control your blood sugar, insulin administration can mean multiple daily injections of insulin. Insulin pumps can serve as an alternative. Instead of injections, the insulin pump delivers a continuous, pre-set amount of insulin, plus bolus doses when needed. While you must still check your blood sugar levels, the pump can take the place of multiple daily insulin injections. While insulin pumps are not without their disadvantages, they can help some people with diabetes obtain better blood glucose control.
What Does An Insulin Pump Do?

An insulin pump is a small device that closely resembles a beeper or miniature computer. Slightly smaller than a deck of playing cards, the insulin pump has several key components:

  reservoir: the reservoir is where the insulin is housed. This must be refilled periodically to ensure a steady stream of insulin.
  cannula: a small needle and straw-like tube inserted subcutaneously, or fatty tissue under the skin, that delivers insulin. The needle is withdrawn while the straw remains. You must switch out the cannula and its site periodically to reduce infection risk.
  operating buttons: These buttons program insulin delivery throughout the day and also deliver mealtime and bolus doses.
  tubing: thin, flexible plastic that transports insulin from the pump to the cannula

For some patients, wearing an insulin pump provides more flexibility to administer insulin doses on the go without the need to carry many diabetic supplies.

Insulin pumps offer two dose types. The first is basal rate, which is a continuous infusion that delivers a small amount of insulin throughout the day. This insulin helps keep your blood sugar levels stable between meals. The other, called a bolus dose of insulin, is given at meal times to help keep blood sugar levels in their target range after you eat a meal.

Your healthcare professional will help you determine both basal and bolus dose amounts based on your blood glucose levels, the time of day, your typical daily routine, and your insulin needs

Wearing an insulin pump means that you must maintain the pump and the pump site. You must alternate your pump’s location every two to three days to avoid infection. You must also refill the insulin reservoir as needed. To make it easier to remember, each time you change your infusion site’s location, plan to change or refill the insulin reservoir within the pump.

Insulin Pumps Better Than Shots for Diabetes Control Dr. Gerald Bernstein directs the Diabetes Management Program at the Friedman Diabetes Institute, part of Beth Israel Medical Center in New York City. He believes that insulin pumps may be the future of diabetes care, but hurdles remain.

Because of insurance-related “inhibitors in our health care system,” use of the devices “has not become common practice in the U.S.,” Bernstein said.

While daily self-injections have been the standard of care for decades, “for many [patients] where personal discipline plays a role, injections just don’t do it,” Bernstein said. Making the switch to an insulin pump also means that “you also need a sophisticated diabetes educator and pump trainer,” he added.

However, Bernstein believes that “the future is bright - pump and continuous monitor use is increasing, which should mean a reduction in price. All of the effort is to improve quality of life, productivity and reduce the risk for complications.”



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