By Lilian Anekwe
Insulin pump therapy is better than injections in adults and children with inadequately controlled type 1 diabetes, according to the results of a randomised controlled trial.
A comparison of sensor-augmented insulin pump and injection therapy, published in the New England Journal of Medicine, found pump therapy reduced hBa1c levels by 0.6 percentage points more than injection therapy.
The trial compared the efficacy of sensor-augmented insulin pumps NovoLog and NovoRapid, both manufactured by Novo Nordisk, and daily insulin glargine injections in 485 patients – 329 adults and 156 children with inadequately controlled type 1 diabetes.
The baseline HbA1c level was 8.3% in both study groups, but after one year HbA1c had decreased to 7.5% in the pump therapy group, compared with 8.1% in the injection therapy group – a statistically significant difference.
The proportion of patients who reached the HbA1c target of 7% or lower was greater in the pump therapy group, at 27%, than the 10% of patients in the injection therapy group who reached the target.
But the rate of severe hypoglycaemia, defined as an episode requiring assistance and confirmed by a blood glucose of less than 50mg per decilitre or 2.8mmol/l, did not differ significantly between the two groups. There were 13.3 cases per 100 person-years in the pump-therapy group and 13.48 per 100 person-years in the injections group.
There was no significant weight gain in either group.
Lead researcher Dr Richard Bergenstal, director of the International Diabetes Center in Minneapolis, concluded: ‘In patients with type 1 diabetes with suboptimal glycaemic control, the use of a sensor-augmented insulin pump was associated with significant improvement in glycated haemoglobin levels, as compared with a regimen of multiple daily injections of recombinant insulin analogues.’
In an accompanying editorial, Dr Howard Wolpert, senior physician at the Joslin Diabetes Center in Boston, wrote: ‘The study and other randomized trials have shown that continuous glucose monitoring can take the management of type 1 diabetes to a new level: improved glycaemic control without an associated increase in hypoglycaemia.’
Dr Andrew Hockey, director for medical operations for Sanofi-Aventis, the manufacturer of Lantus, the injectable insulin used in the trial, said: ‘In the UK, pump therapy is offered to a small proportion of people with type 1 diabetes, and augmented pump therapy in only a fraction of these. This important result is therefore not generalisable to most patients with type 1 diabetes, and a focus has to remain on using the wide range of available therapies to maximum effect to ensure that as many patients as possible reach individual HbA1c targets.’
N Engl J Med 2010; 363:311-320
Insulin pumps provided better glucose control than injections