Insulin Pump Beats Shots in Young Diabetics

July 16, 2004 -- Children and young adults with type 1 diabetes may do better with a continuous insulin pump than a regiment that consists of a long-acting insulin and insulin shots to cover mealtime sugars, a small study shows.

Both the insulin pump and Lantus, a long-acting insulin, are major advances for people with diabetes. Both offer a way to keep blood sugar low throughout the day -- although after meals and large snacks, patients on both regimens often require additional insulin.

Which is better for young patients? Yale diabetes researchers Elizabeth A. Doyle, MSN, and colleagues studied 32 young people aged 8 to 21 with type 1 diabetes. None of them had previously used either the insulin pump or Lantus. For 16 weeks, half the kids got Lantus and half got the pump (the Medtronic MiniMed 508 or Paradigm 511).

The result: Upon waking in the morning, both groups had similar blood sugar levels. The pump group, however, had lower blood sugar before meals and before bedtime.

Perhaps even more importantly, those taking Lantus saw no real change in their HbAIC levels (a drop from 8.2% to 8.1%). Those on the pump had a significant drop, from 8.1% to 7.2%. HbA1C indicates blood sugar levels over the past three months. People with diabetes are supposed to keep their HbA1C levels below 7.0%.

The findings appear in the July issue of Diabetes Care.

"We observed a considerably greater improvement in HbA1C levels with continuous insulin infusion than with [Lantus]," Doyle and colleagues conclude. "It should be noted, however, that no single approach to treatment is ideal for every patient."

The study was partly supported by insulin pump maker Medtronic MiniMed. Several of the researchers have received fees or support from Medtronic MiniMed, and one has received support from Lantus maker Aventis Pharmaceuticals. Medtronic MiniMed is a WebMD sponsor.

SOURCE: Doyle, E.A. Diabetes Care, July 2004; vol 27: pp 1554-1558.