I’ve just come across two interesting pieces of research.
One:
A trial done in Norway between 1995 to 2004, involving 80 kids and adolescents using both multiple daily injections (MDI) and insulin pumps. The trial was set up to study the difference in HbA1c; incidence of hospitalisation for ketoacidosis and severe hypoglycaemia; and patient preference.
It was shown that the HbA1c levels of the patients decreased over time, which also coincided with the adoption of insulin pump therapy (76% of the patients were on pumps by the end of the ten years – unfortunately it doesn’t say what percentage were using them at the start). However, the adoption of insulin pumps didn’t seem to have an effect on the number of hospitalisations from extreme highs or lows.
The study safely concluded that insulin pumps are as good as MDI for treatment of T1. It’s a shame it wasn’t more conclusive, but I suppose the reduction in average HbA1c of 9.1 to 8.3 could have come from a range of factors, including the kids getting older and more attentive to their diabetes.
If you want to read for yourself, you can go here:
Two:
A study in France which compared two groups: one with insulin pumps who monitored their BGs via conventional glucose meters; and the other with insulin pumps integrated with continuous glucose monitoring systems (CGMS).
The results showed that those using the pumps with CGMS integration had more HbA1c improvement, less incidence of hyperglycaemia, but no change in incidence of hypos.
The study for you to read is here:
There are currently CGMS options in NZ, but they are pretty costly. I’m planning to do a post in the next week about these, so if you want to be updated when it goes live, please leave a comment in the box below, and tick “
Posted in CGMS, Hypos & Hypers, Insulin Pumps, Kids & Teens, Science & Research
This post has 12 comments so far. Add yours here, or trackback from your own site.
12 comments have been made on this post
Sarah wrote
That’s the problem with the whole pump thing – when I went off it, I couldn’t get anyone to conclusively tell me I was doing a bad thing and that pump therapy was superior. Everybody shrugged and said ‘Well, it’s better for SOME people, not for all.’ BUT I do think the key to good diabetic control is frequent glucose monitoring coupled with careful carb counting, something you’re made to do when you go on the pump. My years of being on the pump mean that I am heaps more onto it re MDIs. I would so like to have CGMS, although I suspect it might make me a bit edgy and nutty, watching my sugars spike and trough.
Saffy wrote
I think the no 1 key to successful BG management is a persistent diabetes nurse who’s on your case
Bless mine. And then the pump – for me that means no overnight spikes and a clean start to the day. That simple.
r.e. CGMS I’ve just come off a period on one and ARGH I know it has benefits but they’re very temperamental aren’t they? Sarah – what made me nutty was the sensor saying 22 (whatever!) and my testing strip saying 6! Overall tho, a handy tool for seeing trends.
Nic wrote
I agree with both of you…. if it ain’t broke, don’t fix it (i.e. if MDI is working for you, why go to the expense and effort of a pump – it’s definitely harder work). As you say, Sarah – I think it’s hard to distinguish sometimes between the difference the actual insulin pump makes and the training we get alongside it on carb counting and patterns of glucose control.
I still think pumping should be endorsed financially by the government though, because, while it is a choice we make, for some of us (particularly those of us who have spikes overnight, or small children), MDI will never work as well as pumping. Every person’s diabetes is different, and methods of treating it should reflect this.
Alison wrote
I think if you’re not interested in testing then a pump is a bad option as you really need to test more because if the pump stops working there is no long acting insulin hanging around. If you are interested and do a lot of testing then the pump is fantastic. I’ve had people that hardly test (one was in hospital every once in a while from high blood sugars) ask me about the pump thinking it would do everything for them.
I do think they should be funded as you can get good 24hr blood sugars from the basal rate (I never managed that on long acting insulin – I had highs in the night and lows in the day, and I wanted to exercise too!). This has to give you a better hba1c. I can see they’re not for everyone – surely great news for the government – type 1 is a small group of people and not everyone wants a pump so thats an even smaller groupl
Sarah wrote
Yes, I totally agree! Fund the pump! I got caught out because my GP forgot to renew my special authority for Lantas, which totally annoyed me – why should I have to get special dispensation to use a drug that should be freely available? Lantas works so much better for me than protophane etc and yet unless you lobby/petition you have to bumble on with second-rate options.
Nic wrote
I’m not currently able to look this up, but isn’t Lantus available without the special permit now?
Saffy wrote
Alison – eloquently put
Nic & Sarah – I just checked the latest Pharmac schedule (geeky yeah I know) and it appears that you do still have to jump the hoops of annual sign offs of your special authority to get the magic Lantus… yes, sarcasm… coz your Type 1 is going to magically cure itself :p
Sarah wrote
I took my script to the pharmacy and they told me they couldn’t fill it and it would take 10 working days for the special authority to come through. Luckily I found a bottle of lantus behind the condiments and pickles or else I would have had to shell out $120. Special authority through now, my supply is secured!
Kris wrote
Why do the government have to make life so difficult for Type 1s?! I have heard that Levemir may be available in NZ instead of Lantus soon but probably only with the special authority again. Our 7 yr old daughter has been on Lantus for over a year and although we had to split the doses to make it work it was way better than Protaphane. However even better, she has just started on a pump! We paid for it ourselves as the funded ones have a waiting list of 2 years or so in Auckland, and it is totally worth it. We haven’t even been on it for a week & already, in conjunction with the CGMS Starship lent us, we can finally see, & do something about, her pattern of blood sugars. Jean-Ann, the pump nurse, has been fantastic, especially after our less than auspicious start (on the morning of the day to start on the pump, while we were on the motorway stuck in traffic, our daughter started vomiting her guts out! We were allowed to start on it anyway but ended up in Starship on a drip because she vomited more than 20 times in the afternoon. What fun.) I nearly cried at 3am this morning when the CGMS showed her blood sugars had been smooth around our current target of 8 FOR THE LAST 12 HOURS. I never thought I’d see the day! It is a lot of work, but on MDI we were doing just as much work with no damn result at all. Hopefully this will help to smooth out the awful unexplained highs and lows she has…fingers crossed.
Nic wrote
Kris, that is absolutely fantastic news, thanks for updating us! So sorry to hear about your poor girl and the vomiting though, that is seriously horrible. May the pumping continue to be as successful as it has been to date.
Nic
Kate wrote
I am a type 1 diabetic who is currently on Lantus and Humalog. I am struggling to keep my numbers under control.
Does anyone know if there is a product out there that integrates CGMS with an insulin pump (not two devices that talk to each other but one complete unit that does all)
I have checked the net and have not found anything that would meet that requirement!
Thanks
Nic wrote
Hi there Kate
I believe the Paradigm pumps integrate with the Guardian CGMS, but it’s not a closed loop.