By: Daniel Trecroci
Type 1 Kids Do Well on Pumps
In several studies presented at the ADA Scientific Sessions in San Diego,California, insulin pumping demonstrated beneficial effects on a pediatric type1 population.
One study (2770-PO) showed that 75 percent of participants using a pump hadlower A1C levels than they had prior to beginning pump therapy.
Another study (2764-PO) showed that insulin pump therapy was safe and effectivein 27 participants between the ages of 2 and 7 years. Participants experiencedfewer sick days and reduced episodes of severe hypoglycemia. In addition, A1Clevels were significantly improved after patients switched to pump therapy.
In another study (1887-P), 1,041 Medtronic pump users with an average age of11.4 years were studied in 30 centers throughout 17 countries. The study foundthat children who delivered more than five bolus dosages per day using theirinsulin pump had significantly better A1C levels.
“This indicates that by fine-tuning bolus and basal insulin delivery withan insulin pump, patients were able to achieve better blood sugar control,”write the researchers.
Pumping During Pregnancy and Labor Examined in Type 1 Woman
A 29-year-old woman with type 1 for 28 years was studied during her pregnancy(2798-PO). She had been on an insulin pump for five years. A1C levels prior toconception were 5.8% and were 5.1% to 5.6% during the pregnancy. The patient’shourly self-monitored glucose levels during labor and delivery and self-adjustedinsulin doses are shown in the table below.
|Cervical dilation (cm)||2||2||4||6||8||full|
|Mean glucose (mg/dl)||138||109||136||113||65||96|
|Basal insulin dose (units/hour)||0.8||2.0||2.0||3.5||0.5||0.1|
Researchers say that if these findings are confirmed in additional patients,“self-management of glucose monitoring and insulin dose adjustment should beconsidered as a treatment option during labor and delivery in patients with type1 diabetes.”
Insulin-Using Type 2s as Controlled on a Pump as With Multiple DailyInjections
Another study (504-P) found that in older subjects with insulin-treated type2, controlling blood glucose with both an insulin pump and multiple dailyinjections of Humalog at mealtimes and Lantus for basal insulin achieved averageA1C levels of less than 7% with good safety and patient satisfaction. Rates ofsevere hypoglycemia were similar in both groups. Weight gain did not differ.Costs comparisons of the two approaches to insulin therapy were not reported.
Data on Continuous Glucose Monitoring System Help Patients With TreatmentDecisions
Results of a pilot study (363-P) showed that participants successfully usedMedtronic’s Guardian RT Continuous Glucose Monitoring System to better controlglucose fluctuations.
Ninety-four percent of the study participants actively used the real-timeglucose values and/or high or low glucose alerts to control glucose fluctuations;75 percent adjusted their insulin delivery; 63 percent changed their diet; and31 percent made lifestyle changes after gleaning insights from real-timecontinuous glucose monitoring.
The Guardian RT System uses a subcutaneous glucose sensor, which records asmany as 288 glucose readings per day. According to Medtronic, the sensormeasures glucose in the interstitial fluid found between the body’s cells andis typically discarded and replaced after three days of use.