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Insulin pump therapy improves glucose control, total insulin dose in type 2 diabetes
Patients with poorly controlled type 2 diabetes and insulin resistance saw an improvement in glycemic profile and a reduction in total daily insulin dose after switching from multiple daily injections to insulin pump therapy for 12 months, according to findings from a single-center, crossover study.
The study, which included patients using insulin analogue-based multiple daily injection (MDI) therapy plus metformin, was designed to also assess other metabolic outcomes, including body mass, insulin resistance, blood pressure and lipid profile.
Rudolf Chlup, MD, of the department of physiology at Palacky University in Olomouc, Czech Republic, and colleagues analyzed data from 23 patients who were randomly assigned to one of two groups: an insulin pump therapy arm (MiniMed Vio, Medtronic; n = 11) or an MDI continuation arm (n = 12) for 6 months. Included patients had persistent HbA1c of at least 8% (mean, 9.5%), mean BMI of 36.2 kg/m² and mean diabetes duration of 13.3 years. At 6 months, all but one patient in the MDI arm crossed over to the insulin arm for an additional 6 months of follow-up.
At 6 months, patients in the pump therapy arm saw a mean HbA1c reduction of 0.9% (95% CI, –1.6 to –0.1) from baseline while reducing total daily insulin dose by a mean 29.8 U per day (33% from baseline). Patients in the pump therapy group also saw a mean BMI reduction of 0.3 kg/m² (95% CI, –1.61 to 0.99) and a mean body weight reduction of –0.78 kg from baseline (95% CI, –4.55 to 2.99). Patients in the MDI group saw a nonsignificant reduction in HbA1c of 0.3% from baseline (95% CI, –0.8 to 0.1) and a total daily insulin dose reduction of 0.4 U per day (5% from baseline), as well as a BMI reduction of –0.31 kg/m² (95% CI, –0.78 to 0.16) and a body weight reduction of 1 kg (95% CI, –2.36 to 0.36). The between-group difference in HbA1c reduction was –0.53% in favor of the pump therapy arm, but this did not rise to significance, according to researchers.
At 12 months, the combined cohort saw a mean 1.2% reduction in HbA1c from baseline, with 41% of patients achieving HbA1c of 8% or less, and a mean reduction in total daily insulin dose of 13.7 U per day. There was no change in body weight at 12 months, and no changes in BP or lipid profile that rose to significance.
There were no incidents of diabetic ketoacidosis or sever hypoglycemia in either arm, according to researchers.
They noted that the finding that only 41% of the patients achieved HbA1c of 8% or less, along with a lack of change in body mass, suggests that a potential combination of pump therapy with incretins or SGLTs inhibitors may be worth exploring.
“While an optimum metabolic balance in most of the patients was not reached, treatment adherence and satisfaction were excellent,” the researchers wrote. “All subjects decided to continue using [insulin pump] therapy.” – by Regina Schaffer
Disclosures: All authors report they are employees of Medtronic.