Sensor-augmented insulin-pump therapy effective for type 1 diabetes patients

Adding a continuous blood sugar level sensor to an insulin pump helps patients with type 1 diabetes achieve better blood sugar control compared to the common standard of care, multiple daily insulin injections, concludes a study published on-line today in the New England Journal of Medicine.

The paper is entitled, Effectiveness of Sensor-Augmented Insulin-Pump therapy in Type 1 Diabetes.

"Combining the best technologies for insulin delivery and blood sugar monitoring really pays off for diabetes control," says Dr. Bruce Perkins, one of the co-authors of the study, endocrinologist at Toronto General Hospital and Assistant Professor at the University of Toronto. "Being aware of continuous blood sugar trends and having the tools to do something about them can help committed patients of all ages self-manage their diabetes very well."

Research conducted at 30 centres across North America, including Toronto General Hospital, found a significant decrease in average blood sugar levels (or A1c levels, which measure the average blood sugar levels over the past two or three months) from a baseline of 8.3% to 7.5% in the group using sensors and insulin pumps, compared to 8.3% to 8.1% in the multiple daily injection group, at one year. The decrease in A1c levels in both adults and children occurred without an increase in the rate of severe hypoglycemia, or low blood sugar, a common problem among patients who are trying to achieve better control of their blood sugar. Symptoms include shakiness, rapid heart beat, confusion and even unconsciousness.

Moreover, the proportion of participants who reached the A1c target of 7% or less was greater in the pump-therapy group than in the injection-therapy group. Adults with diabetes try and maintain A1c levels of seven percent or below in order to reduce the risk of complications from diabetes, such as kidney failure, heart disease and blindness.

The 485 study participants with inadequately controlled type 1 diabetes ranged in ages from seven to 70, and were treated for at least one year, in a randomized, controlled trial.

In the study, patients in the sensor-augmented pump therapy arm used an integrated system which incorporates an insulin pump, continuous glucose monitor and self-management software. A glucose (sugar) sensor reveals fluctuations in glucose levels in real-time, and transmits electric signals wirelessly to the insulin pump, which is about the size and shape of a small cell phone. The pump displays the blood sugar levels, allowing patients to react to either high or low levels before they become dangerous.

The study was sponsored by Medtronic, Inc.; and supported by Novo Nordisk; Lifescan; Bayer Heathcare; and Becton Dickinson.

• More than 2.4 million Canadians have some form of diabetes.
• Over 240,000 Canadians live with type 1 diabetes.
• Canada has the sixth highest incidence rate of type 1 diabetes in children 14 years or younger in the world.
• The incidence rate of type 1 diabetes is rising by three to five per cent in Canada; the greatest rise occurs in five to nine year olds.
• The cause of type 1 diabetes remains unknown. People are usually diagnosed with type 1 diabetes before the age of 30, most often during childhood or their teens.
• Over time, high blood glucose levels can cause complications such as blindness, heart disease, kidney problems, nerve damage and erectile dysfunction.
• Insulin therapy is the cornerstone of treatment for type 1 diabetes. There are a variety of insulins to help manage type 1 diabetes. Insulin can be administered by syringe, pen or pump.
• By 2010, it is estimated that diabetes will cost the Canadian healthcare system $15.6 billion a year, and that number will rise to $19.2 billion by 2020.
• A person with diabetes can be faced with medication and supply costs up to $15,000 a year.