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Pump therapy reduced HbA1c levels in patients with type 2 diabetes
Patients with type 2 diabetes who undergo insulin pump therapy achieve a larger reduction in HbA1c than those who remain on a multiple daily insulin injection regimen, according to findings from the OpT2mise trial.
In the trial, researchers evaluated patients with type 2 diabetes aged 35 to 70 years who were on multiple daily injection (MDI) regimens and high insulin doses 90.5-1.8 U/kg/day). The regimens were titrated during a 2-month run-in phase. With the exception of metformin, all oral diabetic medications were discontinued.
Plasma assays for C-peptide and anti-glutamic acid decarboxylase antibody were conducted at baseline and at the end of the study period (6 months). Patients were stratified according to anti-glutamic acid decarboxylase antibody and C-peptide concentrations. Researchers evaluated possible associations between these biomarkers and baseline HbA1c, changes in HbA1c and HbA1c changes related to treatment group assignment.
Patients with HbA1c values ranging between 8% and 12% were randomly assigned to pump therapy (n=168) and continued MDI (n=163).
The researchers found that at the end of the 6-month study period, the patients in the pump cohort achieved better glucose control (decrease in HbA1c from 9% to 7.9%). Between the two groups, there was an HbA1c difference of 0.7% favoring pump therapy (P<.001). Moreover, the total daily dose of insulin was decreased by 20% with the pump vs. MDI, suggesting that the continuous infusion through the pump increased insulin sensitivity.
There was no association between baseline HbA1c values and anti-glutamic acid decarboxylase antibody or C-peptide concentrations. The researchers did note a difference between pump vs. MDI groups among patients with C-peptide concentrations <156 pmol/L. No significant difference was seen between the groups in terms of HbA1c reduction based on the presence or absence of anti-glutamic acid decarboxylase antibody.
According to the researchers, these findings suggest that anti-glutamic acid decarboxylase antibody and C-peptide concentrations should not be used to guide treatment decisions regarding pump therapy.
“The benefits of pump therapy were not dependent on either [anti-glutamic acid decarboxylase antibody] detection or [C-peptide concentrations] at baseline,” the researchers wrote. “Therefore, the presence or absence of these biomarkers should not be used as a criterion for insulin pump therapy in [type 2 diabetes] patients unable to achieve glycemic control on MDI.”
Disclosure: One researcher reports financial ties with Medtronic.