Insulin pumps have been shown to improve glycemic control in adults with type 1 diabetes based on evidence from randomized controlled trials and meta-analyses. The evidence is mixed for glycemic control benefits in children, though some studies and meta-analyses favor insulin pumps. Insulin pumps reduce the risk of microvascular complications and glycemic variability even when average blood sugar levels are similar to multiple daily injections. The risk of hypoglycemia is similar for pumps and injections, while the risk of ketoacidosis depends on experience with pump use. Importantly, insulin pumps consistently improve quality of life for people with type 1 diabetes.
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Insulin Pump- Evidence from Current Era.
1. INSULIN PUMP- EVIDENCE
FROM CURRENT ERA
F.A.Q. FROM PATIENTS AND REFERRING
DOCTORS ANSWERED WITH EVIDENCE
DR. OM J LAKHANI
MD, DNB (ENDO)
CONSULTANT ENDOCRINOLOGIST
ZYDUS HOSPITALS
AHMEDABAD
24. There was a statistically
significant
difference in HbA1c favouring
CSII - weighted mean difference -
0.3% (95% confidence interval -
0.1 to -0.4).
36. In studies that included
participants less than 18 years of
age the mean difference of
HbA1c was estimated to be -
0.2%(95%CI -0.4 to -0.03) in favour
of CSII compared with MI.
45. At 1 year, the baseline mean
glycated hemoglobin level (8.3%
in the two study groups) had
decreased to 7.5% in the pump-
therapy group, as compared with
8.1% in the injection-therapy
group (P<0.001).
46.
47. An Extension cross-over study (6
months extension) showed
continued benefit for those
already on pump and those
switched from MDI to Pump
48.
49. Answer- The newer sensor
augmented insulin pumps
produce significant HbA1c
reduction.
56. The Mean HbA1c in both the
groups was similar.
Around 8.6%
57. Though pumps lead to lower risk
of Microvascular complications -
the difference was not statistically
significant
58.
59. However, in a multivariate
analysis when confounding
factors were (Higher HbA1c at
beginning of treatment, older age,
longer duration of disease) were
factored in the analysis- the risk
of microvascular complications
was lower in the CSII group.
75. This is an Cross-over RCT which
compared the use of bio
hormonal bionic pancreas with
conventional insulin pump for 5
days
76. The mean frequency of
interventions for hypoglycemia
among the adolescents was lower
during the bionic-pancreas period
than during the control period
77. Among the adults, the bionic
pancreas, as compared with their
usual care, reduced the time that
glucose levels were below 60
mg/dl by 67% (by 94% during the
overnight period).
79. Answer- Insulin pumps do not
reduce the risk of Hypoglycaemia
- this holds true for both mild as
well as severe hypoglycaemia.
Biohormonal bionic pancreas may
have advantage in this area.