Insulin Pumps Fall Short of Real Life Expectations

A new study reveals that nearly 40% of adult insulin pump users fail to maintain control of hemoglobin A1C (HbA1C) glycemic levels over time.

Researchers at the University of Manchester (United Kingdom) and the University of Cambridge (United Kingdom) conducted a retrospective study of 2,079 HbA1C levels tests among 484 patients (mean age 41, 56% female) who used continuous subcutaneous insulin infusion (CSII) for 12 months or more. The mean CSII duration was four years, and the mean time between the start of the pump use in average HbA1C levels was 34.7 months; the longest follow-up was 3.3 years.

The results showed an improvement of 0.6% in HbA1C with CSII use, with greater improvements among patients with initial levels higher than 8.5%. Unfortunately, only 31.2% of the patients achieved good control (i.e., HbA1C levels lower than 7.5%). Many of the patients had poor glycemic control (HbA1C higher than 8.5%) or very poor control (over 10%). Age, duration of diabetes, and length of follow-up were not significant factors, and neither was pump type. The study was presented at the 75th scientific sessions of the American Diabetes Association (ADA), held during June 2015 in Boston (MA, USA).

“Contrary to our expectations more than a third had poor control and 11% had very poor control. The data highlight the challenges of managing type 1 diabetes in real-life conditions, which may vary from research settings,” said lead author Lalantha Leelarathna, MBBS, PhD, of Cambridge University. “Many patients on CSII continue to have poor control; further work is required to understand the factors associated with poor control, especially in younger patients.”

HbA1c refers to glycated hemoglobin, used to identify average plasma glucose concentration over prolonged periods of time. For people without diabetes, the normal HbA1c range is 4%–5.6%. HbA1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. The goal for diabetics is HbA1c levels less than 7%, which should be retested every three months to determine target level control.

Related Links:
University of Manchester
University of Cambridge