Insulin pumps better than injections for glucose control: study

Insulin pumps are significantly more effective at controlling blood glucose in people with type 2 diabetes whose disease has not responded to the usual standard of care, multiple daily insulin injections, according to the largest international study to examine the safety and effectiveness of the pumps to treat type 2 diabetes, published in The Lancet.

In the OpT2mise trial, 331 participants aged 30 to 75 years were randomly assigned to pump therapy or to continue with multiple injections of insulin. The pumps outperformed multiple daily injections on several measures:

• At six months, a significantly greater reduction in average blood glucose levels was achieved in those who used the pump compared with those who used multiple daily injections.
• Twice as many people had HbA_1c levels that reached the target range of 8 percent or less in the pump-therapy group compared with the injection group (55 percent versus 28 percent).
• Those using the pump spent, on average, almost 3 hours less every day in hyperglycemia (when blood sugar becomes too high).
• At the end of the study, the daily dose of insulin was 20 percent lower with pump therapy than with multiple injections.

The time spent in hypoglycemia—when blood sugar becomes extremely low—remained similarly low with those using the pump and those taking multiple daily injections. No weight difference was observed in participants from both groups.

"Pumps enhance effective insulin absorption and increase insulin sensitivity thanks to the continuous daily subcutaneous insulin delivery," says lead author Yves Reznik, MD, PhD, of University of Caen Côte de Nacre Regional Hospital Center, Caen, France. "Our findings open up a valuable new treatment option for those individuals [whose conditions are] failing [to respond] on current injection regimens and may also provide improved convenience, reducing the burden of dose tracking and scheduling, and decreasing insulin injection omissions."

Commenting on the study, Pratik Choudhary, MD, of King's College London, wrote, "OpT2mise provides a compelling case for the clinical effectiveness of insulin pump treatment in type 2 diabetes, suggesting that it can help improve glycaemic control in this difficult-to-treat group of patients [in whom] glucose control [is unable to be achieved] despite increasing doses of insulin. However, cost effectiveness of pumps in different healthcare systems will need to be evaluated."