Insulin pumps improve diabetes control

Continuous insulin infusion delivered by a portable pump allows young people with type 1 diabetes to maintain better control of their blood sugar levels than is possible with multiple daily injections of insulin, according to a new report.

Dr. Revital Nimri and colleagues from Schneider Children's Medical Center of Israel, Petah Tiqwa, analyzed glucose control and adverse events in 279 patients ranging from toddlers to young adults who switched to pump therapy from their previous therapy.

The main measure was the change in glycosylate hemoglobin, commonly referred to as HbA1c. The percentage of hemoglobin that has glucose attached - that is, HbA1c - gives a picture of how well glucose levels in the blood have been regulated over the preceding 5 to 6 weeks. Since HbA1c concentrations are typically about 5 to 8 percent, a change of around half a percent is quite substantial.

In the present study, HbA1c levels improved by 0.51 percent for the entire group of patients after switching to the insulin pump, the investigators report in the medical journal Pediatrics. The improvement was seen in all groups, including pre-pubertal youngsters (0.48 percent improvement), adolescents (0.26 percent improvement), and young adults (0.76 percent improvement).

HbA1c levels continued to fall with increasing duration of infusion up to 3 years, the results indicate, after which there was no significant decrease in HbA1c.

Episodes of excessively low blood sugar levels, which can be dangerous, decreased significantly in the adolescent and young adult groups, the researchers note.

"Continuous subcutaneous insulin infusion improves (blood glucose) control in children and adolescents with type 1 diabetes, especially those with a history of moderate to poor glycemic control," the team concludes.

This improvement, they add, is achieved without a significant increase in major catheter-site infection, or weight gain.

SOURCE: Pediatrics, June 2006.