The following are summaries of studies presented at the June 2004 ADA Scientific Sessions in Orlando, Florida:

Progress Being Made on Artificial Pancreas

French researchers are saying that once “tuning optimization” is achieved, the implantable Physiologic Insulin Delivery (iPID) artificial pancreas system will provide automated control of blood glucose.

The iPID system was evaluated in four people with type 1. The participants, who already had implanted blood glucose sensors connected to an implanted Medtronic MiniMed pump, were admitted to the Montpellier Research Center for three days. Closed-loop control was initiated using a beta cell-emulating algorithm and continued for 48 hours.

A meal consisting of 40 grams of carbohydrate was served each day at 8 a.m., followed by an 80-carb-gram lunch at 1 p.m. and an 80-carb-gram dinner at 7 p.m.

Blood glucose was assessed every 10 minutes for the first two hours of meals and every 30 minutes otherwise.

During closed-loop control, the algorithm kept blood glucose within 80 to 240 mg/dl 84 percent of the time.

The researchers write that “Algorithm retuning did not change the percentage of glucose less than 240 mg/dl, but increased the percentage within the 80 to 120 mg/dl range during the final 24 hours.”

Source: Abstract 482-P

Can You Pump With Apidra?

The rapid-acting insulin analog glulisine (Apidra) is safe in insulin pumps, according to European researchers.

Apidra, which is manufactured by Aventis, was compared to rapid-acting insulin analog aspart (NovoLog) in a 12-week multicentered study. A total of 59 people with type 1 who had previous experience using an insulin pump were given either Apidra or NovoLog in their pumps.

There was a low rate of catheter blockages in both the Apidra and NovoLog groups, and the average rate of catheter changes was similar in both groups (14.1 versus 14.8, respectively). Infusion-site reactions were also similar in both groups (three patients versus four patients, respectively).

Average daily insulin doses were similar in both groups.

Source: Abstract 15-OR

Pumping Lowers Your Basal Doses

People making the transition from multiple daily insulin injections to an insulin pump can expect an 18 to 22 percent decrease in their total basal insulin requirements.

According to a study presented by Irl Hirsch, MD, of the University of Washington, Seattle, when transitioning from injections to a pump, most providers suggest an initial decrease in basal insulin of 20 to 25 percent. In a chart review of 31 people with type 1 who initiated pump therapy between July 1, 2001, and June 30, 2003, Hirsch found the following:

• Basal doses for all patients decreased an average of 21.7 to 17.8 units
• A1Cs decreased from an average of 7.4% to 7%
• Average blood glucose decreased from 173 mg/dl to 169 mg/dl

Source: Abstract 466-P

Bolus Frequency Related to Better A1Cs in Kids Who Pump

In type 1 children and adolescents on pump therapy, the use of more frequent boluses is associated with lower A1Cs.

Members of the Pedpump Study Group analyzed the data stored in the memory of kids’ insulin pumps. Patients using the Medtronic MiniMed 508 pump (which has a 90-day memory of insulin delivery) were invited to participate.

In all, data from 377 participants were recorded.

“Overall, A1C was significantly lower in patients using more frequent boluses,” write the researchers.

Source: Abstract 1760-P