The following are summaries of studies presented at the June2004 ADA Scientific Sessions in Orlando, Florida:
Progress Being Made onArtificial Pancreas
French researchers are saying that once“tuning optimization” is achieved, theimplantable Physiologic Insulin Delivery(iPID) artificial pancreas system will provideautomated control of blood glucose.
The iPID system was evaluated in fourpeople with type 1. The participants, whoalready had implanted blood glucosesensors connected to an implantedMedtronic MiniMed pump, were admittedto the Montpellier Research Center for threedays. Closed-loop control was initiatedusing a beta cell-emulating algorithm andcontinued for 48 hours.
A meal consisting of 40 grams ofcarbohydrate 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 10minutes for the first two hours of meals andevery 30 minutes otherwise.
During closed-loop control, the algorithmkept blood glucose within 80 to 240 mg/dl84 percent of the time.
The researchers write that “Algorithmretuning did not change the percentage ofglucose less than 240 mg/dl, but increasedthe percentage within the 80 to 120 mg/dlrange 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, accordingto European researchers.
Apidra, which is manufactured by Aventis,was compared to rapid-acting insulinanalog aspart (NovoLog) in a 12-weekmulticentered study. A total of 59 peoplewith type 1 who had previous experienceusing an insulin pump were given eitherApidra or NovoLog in their pumps.
There was a low rate of catheter blockagesin both the Apidra and NovoLog groups,and the average rate of catheter changeswas similar in both groups (14.1 versus 14.8,respectively). Infusion-site reactions werealso similar in both groups (three patientsversus four patients, respectively).
Average daily insulin doses were similar inboth groups.
Source: Abstract 15-OR
Pumping Lowers Your BasalDoses
People making the transition from multipledaily insulin injections to an insulin pumpcan expect an 18 to 22 percent decrease intheir total basal insulin requirements.
According to a study presented by Irl Hirsch,MD, of the University of Washington, Seattle,when transitioning from injections to apump, most providers suggest an initialdecrease in basal insulin of 20 to 25 percent.In a chart review of 31 people with type 1who initiated pump therapy between July1, 2001, and June 30, 2003, Hirsch found thefollowing:
- Basal doses for all patients decreased anaverage of 21.7 to 17.8 units
- A1Cs decreased from an average of 7.4% to7%
- Average blood glucose decreased from 173mg/dl to 169 mg/dl
Source: Abstract 466-P
Bolus FrequencyRelated toBetter A1Cs inKids Who Pump
In type 1 children andadolescents on pumptherapy, the use of morefrequent boluses isassociated with lower A1Cs.
Members of the PedpumpStudy Group analyzedthe data stored in thememory of kids’ insulinpumps. Patients using theMedtronic MiniMed 508pump (which has a 90-daymemory of insulin delivery)were invited to participate.
In all, data from 377participants were recorded.
“Overall, A1C wassignificantly lower inpatients using morefrequent boluses,” writethe researchers.
Source: Abstract 1760-P