Tubeless insulin pumps offer durable alternative to MDI in adolescents
medwireNews: Tubeless insulin pump use can provide long-term improvements in glycemic control at a lower total daily dose of insulin compared with multiple daily injections (MDI), show results of a retrospective study among children and young adults with type 1 diabetes.
Thomas Danne (Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany) and colleagues report that mean glycated hemoglobin (HbA1c) level fell from 7.6% at baseline to 7.5% at 1 year in the 660 individuals (mean age 11.5 years) who switched from MDI therapy to a tubeless insulin pump.
By comparison mean HbA1c increased from 7.6% to 7.7% during the same time period in the 1869 individuals (mean age 12 years) who continued MDI treatment, resulting in a significant between-group after adjustment for baseline HbA1c, age, sex, and diabetes duration.
However, mean HbA1c increased to 7.8% and 8.0% by years 2 and 3, respectively, in both groups, which the researchers say is consistent with previous data showing that glycemic control worsens with puberty.
They also comment that the relatively well-controlled HbA1c levels in both groups at baseline “may have limited the potential for a greater difference in HbA1c after treatment switch that might occur in less well-controlled pediatric populations.”
Mean daily insulin dose was significantly lower in the individuals using a tubeless insulin pump compared with those continuing with MDI for the duration of the study, with values of 0.80 versus 0.89 U/kg, 0.81 versus 0.94 U/kg, and 0.85 versus 0.97 U/kg recorded at years 1, 2, and 3, respectively.
By contrast, BMI standard deviation score did not differ significantly between the two groups but increased in both at a similar rate over time.
Danne et al conclude in Pediatric Diabetes: “Overall, the results of the present study are clinically meaningful: a relatively good level of glycemic control with a lower total daily insulin dose was observed over time with tubeless insulin pump use compared to MDI.”
They add: “Although registry data is unable to show superiority or inferiority of one mode of therapy compared to another, switching to tubeless insulin pump therapy appears as an effective alternative to MDI in youth with [type 1 diabetes].”
By Laura Cowen
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