Insulin Pump Better Than Multiple-Shot Regimen for Diabetics
June 8, 2000 -- A new study confirms that insulin pumps are more effective
than multiple daily insulin shots at helping type 1 diabetics' control their
blood sugar and can lower the total daily insulin dose they need. This is
especially true if the patients take a large portion of the dose at mealtimes,
says the study, published in the journal Endocrine Practice.
Diabetics' bodies fail to produce enough of the hormone insulin, which
regulates blood sugar. Without insulin, blood sugar stays dangerously high, and
can cause serious complications, including blindness and kidney failure. Type 1
diabetes usually occurs in childhood, and people with this type of diabetes
must take insulin to stay in good health. Insulin can be taken by injection or
by the pumps, devices worn like a fanny-pack that deliver programmed doses of
the drug under the skin of the wearer's abdomen.
For the study, Linda M. Crawford, BA, of the Dartmouth Medical School, in
Lebanon, N.H., and colleagues reviewed the cases of 19 people with type 1
diabetes. The patients, aged 30-58, had switched from a multiple-shot regimen
to an insulin pump system between 1991 and 1997. Most had asked to be put on
pump therapy to improve their blood sugar control and to reduce the frequency
of their bouts of low blood sugar.
The patients started with a daily insulin dose equaling 80% of that they had
been taking before going on the pumps. Half the dose was given throughout the
day as "background" insulin, and the other half was given at mealtimes.
The patients checked their blood sugar levels six to seven times a day. They
were followed for an average of 14 months.
The researchers found that HbA1C , an important measure of the
patients' blood sugar, significantly decreased after they switched to the pump.
Their weight also decreased, from an average of 153 pounds at the beginning of
the study to 152 pounds. And their total daily dose of insulin decreased by
One interesting finding was that the amount of insulin the participants used
between meals decreased, while the amount used at mealtimes increased. The
patients achieved appropriate premeal doses by more closely monitoring their
own blood sugar and by counting carbohydrates, the study's authors say.
"This article confirms what others have confirmed: that with the pump,
we can lower HbA1C, which means improving [blood sugar]
control," says Bruce Bode, MD, who reviewed the study for WebMD. "That
translates into a reduction in complications." Bode is an endocrinologist
at Atlanta Diabetes Associates and medical director of the Diabetes Resource
Center at Piedmont Hospital, also in Atlanta. He is also a consultant for
Mini-Med, an insulin pump manufacturer, and for insulin makers Novo and Eli