Insulin Pump Therapy Better than MDI for Adolescents
A multi-discipline team from Yale University led by Elizabeth Boland, MSN, APRN, PNP, CDE, in conjunction with MiniMed, studied a large group of adolescents with Type 1 diabetes. They compared insulin pump use versus multiple daily injections (MDI) to determine if either yielded better clinical and psychosocial results. Their study, published in the November 1999 issue of Diabetes Care, demonstrates that insulin pumps provide better control as evidenced by lower HbA1c, a significantly reduced risk of severe hypoglycemia, and no adverse psychosocial impact.
Key results of the study were:
- Teens using the pump sustained lower HbA1c levels than those using MDI
Pump users: at 6 mo, 7.7; at 12 mo, 7.5
MDI users: at 6 mo, 8.1; at 12 mo, 8.3
- Pump users experienced fewer episodes of severe hypglycemia
Pump users: 76 (per 100-patient years) MDI users: 134 (per 100-patient years)
- Insulin use was lower in pump users after 12 months
Pump users: 1.05 +/- 0.4 U/kg
MDI users: 1.49 +/- 0.6 U/kg
As a prelude to presenting the study results, Boland and her team state what many parents and teens who use pumps have felt: "CSII appears to be a much more viable alternative than multiple daily injections (MDI), which involves >=3 injections of insulin a day, in the intensive management of adolescents with type 1 diabetes." Teens eager to initiate pump therapy can now cite this study as evidence of the advantages of a pump compared with multiple daily injections.
Diabetes Care Editorial
The acompanying lead editorial for the issue, entitled Improving Diabetes Control in Adolescents, reiterates what we all know: caring for diabetes during adolescence is harder than it is before or after. The reasons are many, but regardless, the challenge for parents and diabetes teams remains to find a way to provide the best care possible during the teen years. The editor notes that while there is increasing interest in the use of pumps in adolescents, there is precious little in the way of published studies to show a benefit. This makes the current study all the more valuable and important. Noting the challenge, the editor shares the following advice:
Modern management of this disease, therefore, requires teamwork. This was one of the most important messages of the DCCT and was, undoubtedly, an important reason for the success achieved by Boland and her colleagues. Diabetes clinics and office practices with fewer resources are unlikely to be able to emulate these results. This should not, however, detract from the message: with appropriate diabetes education, self-management training, support, and the use of a physiologic insulin-replacement regimen [the pump, Ed.], adolescents can improve their diabetes control.
From Continuous Subcutaneous Insulin Infusion: A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes (Diabetes Care 22:1779-1784, 1999).
For More Information
- Continuous Subcutaneous Insulin Infusion: A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes (Full Text Article)
- Improving Diabetes Control in Adolescents (Full Text Article)
- PubMed abstract
Posted 11 November 1999
Updated 9 August 2004
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