Newer technologies for type 1 diabetes control are better, finds study
Despite higher cost, people with type 1 diabetes who use insulin pumps and continuous glucose monitoring devices are happier and spend less time with high blood sugars than patients who monitor their blood sugar and inject insulin, finds a new study.
Quality of life better with continuous monitors, insulin pumps
The study, conducted by Johns Hopkins researchers and published online in the Annals of Internal Medicine, found that patients who use the an insulin pump that automatically monitors glucose levels and delivers insulin felt more satisfied with the treatment and experience better quality of life.
“Our study was designed to help patients and physicians better understand the effectiveness of insulin pumps and blood sugar sensors that provide constant glucose monitoring compared to conventional approaches,” says the study’s senior author, Sherita Hill Golden, M.D., M.H.S. in a press release. We found that certain devices confer real benefits.”
Because the body can’t regulate blood sugars because the body can’t make insulin when type 1 diabetes is present, people with the disease have to monitor their sugars frequently and give themselves insulin injections.
That means frequent finger pricks and using a diabetes monitor with testing strips that can be tedious and interfere with activities. The need to check blood sugar and take insulin or eat if sugars are too low can happen throughout the day, depending on the individual.
For the current study Golden and her colleagues did a review and re-analysis of data from 33 randomized controlled trials.
The research team compared the newer technologies to conventional methods of monitoring and controlling blood sugar levels. The new technologies they explored were continuous glucose monitoring devices and insulin pumps.
Continuous monitoring devices check blood sugar levels as often as every 5 minutes by way of a sensor attached to the abdomen. There is a small needle taped in place. Depending on the blood sugar readings, diabetics can adjust their insulin, food intake and activities. There is still a need to check the device against results from a traditional glucometer to ensure accuracy, but the need is less frequent than without the continuous monitor. The readout is displayed on a belt and an alarm sounds if sugars are too high or too low.
Insulin pumps can be used one of two ways. They are either set up to deliver insulin with the push of a button by way of a small tube and needle that sits just under the skin of the belly and based on glucometer blood sugar readings, or they can be linked to a continuous blood sugar monitor; known as a “sensor-augmented pump.”
The study results showed type 1 diabetics – children, teens and adults - who used continuous glucose monitors maintained lower blood sugar levels compared to finger sticks alone and they also spent less time with high blood sugar levels or hyperglycemia.
Use of insulin pumps with ‘sensor augmented’ control was associated with overall better blood sugar control. Using the insulin pump for medication delivery compared to giving multiple insulin shots each day worked the same for blood sugar control.
Golden emphasized that using the devices appropriately for type 1 diabetes is essential. The study didn’t take into account people over age 65. Not all insurance companies cover newer technologies for type 1 diabetes nor does Medicare. It might be worth asking your doctor to submit a request for approval to your insurance company that could possibly help you obtain an insulin pump or continuous glucose monitor.
Annals of Internal Medicine
"Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus: A Systematic Review and Meta-analysis"
Hsin-Chieh Yeh, PhD, et al.
July 10, 2012
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