Insulin Pump Therapy In Type Research Articles

Insulin pump therapy in type 1 diabetes is associated with lower indices of Non-Alcoholic Fatty Liver in non-obese women but not men

AimNon-Alcoholic Fatty Liver Disease (NAFLD) is a raising concern in type 1 diabetes (T1D) patients. We evaluated whether multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) may differentially affect NAFLD. MethodsNAFLD was assessed by Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) in 659 T1D patients treated by MDI (n = 414, 65% men) or CSII (n = 245, 50% men) without alcohol abuse or other liver diseases. Clinical and metabolic differences between MDI and CSII participants were also evaluated according to sex. ResultsCompared with the MDI cohort, CSII users had a significantly lower FLI (20.2 ± 21.2 vs. 24.8 ± 24.3; p = 0.003), HSI (36.2 ± 4.4 vs. 37.4 ± 4.4; p = 0.003), waist circumference (84.6 ± 11.8 vs. 86.9 ± 13.7 cm; p = 0.026), plasma triglyceride (76.0 ± 45.8 vs. 84.7 ± 58.3 mg/dl; p = 0.035), and daily insulin dose (0.53 ± 0.22 vs. 0.64 ± 0.25 IU/kg body weight; p < 0.001). In CSII users, lower FLI and HSI were observed in women (p = 0.009 and p = 0.033, respectively) but not in men (p = 0.676 and p = 0.131, respectively). Women on CSII also had lower daily insulin doses, plasma triglyceride, and visceral adiposity index than women on MDI. ConclusionCSII is associated with lower NAFLD indices in women with T1D. This may relate to the lower peripheral insulin in the context of a permissive hormonal milieu.

Effect of a lifestyle intervention to prevent weight gain at initiation of insulin pump therapy in type 2 diabetes: A randomized, controlled, multicentre trial

Insulin pump therapy improves glycaemic control in individuals with type 2 diabetes. However, it may be associated with weight gain. Aim: To test the effectiveness of a six-month dietary and physical activity intervention, compared to usual care, on weight gain prevention after initiation of insulin pump. Methods: Multicentre randomized, controlled trial of 54 individuals. Primary endpoint was between group difference in weight gain at six-months. Results: Weight gain after 6 months of insulin pump treatment did not differ between groups: mean 3.2 (3.9) kg in the control group and 3.9 (3.8) kg in the intervention group, (p = 0.56). HbA1c improved without difference between groups. Post-hoc multivariate analysis of all participants found that weight gain was independently associated with younger age, active smoking, and the magnitude of HbA1c reduction. A 1 % decrease in HbA1c was associated with an increase of 0.94 kg [95 % Confidence Interval 0.47; 1.41], p < 0.001. Conclusions: Treatment intensification by insulin pump therapy in patients with type 2 diabetes is effective to improve glycaemic control. A gain of about 1 kg per 1 % drop in HbA1c can be expected after insulin treatment intensification. This weight gain was not prevented by a home-base, individualized, 6-months lifestyle intervention program.

Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion.

Numerous studies have demonstrated the clinical value and safety of insulin pump therapy in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for insulin pump coverage required by the Centers for Medicare & Medicaid Services (CMS) discount conclusive evidence that supports insulin pump use in diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the insulin pump eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.

37 - The Impact of Government-Funded Insulin Pump Programs on Insulin Pump Use in Canada: A Cross-Sectional Study Using the National Diabetes Repository

Despite the benefits and cost-effectiveness of insulin pump therapy for type 1 diabetes (T1D), funding for insulin pumps varies by province. This study assessed the impact of government-funded insulin pump programs on insulin pump use.

1257-P: Quality Improvement Project to Increase Insulin Pump Use in Pediatric Type 1 Diabetes

Background: Insulin pump therapy in type 1 diabetes (T1D) has been associated with lower hemoglobin A1c than multiple daily injections. In the T1D Exchange, 63% of pediatric patients &amp;lt;18 years old in 2013-14 used pumps. However, pump use at our institution in 2015 was much lower at 39.4% (551 of 1399 patients &amp;lt;18 years old with T1D duration ≥1 year attending clinic at least twice yearly). A multidisciplinary team of pediatric endocrinologists, diabetes educators, and hospital leaders implemented a QI initiative aimed to increase pump use to ≥50%. Methods: Pump use was extrapolated from diabetes providers’ visits in the electronic medical record (EMR) and tracked via a run chart. A series of plan-do-study-act (PDSA) cycles were implemented, including: 1. Creation of introductory and advanced pump handouts for patients. 2. Quarterly technology sessions for providers and clinic staff to improve pump knowledge. 3. Creation of pump start orders in the EMR. 4. Certification of the clinic’s diabetes educators in all commonly used pumps. 5. Scheduled diabetes educator visits for all patients after pump initiation. Results: Pump use increased from 39.4% (551 of 1399 patients) in 2015 to 50.6% (730 of 1442 patients) in 2018 (Image 1). Conclusion: The aim of increasing pump use to ≥50% of our clinic’s population was achieved over 3 years. Building on this success, future direction is to evaluate impact on bolus frequency and association with HbA1c. Disclosure S. Lyons: None. N.L. Canada: None. K. Hernandez: None. J.E. Segovia: Consultant; Self; Insulet Corporation. S.K. Bartz: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. S. Mckay: None. R. Sonabend: None.

1043-P: Glycemic Profiles and Treatment Patterns: Real-World Data from 8,020 Adults with Type 1 Diabetes Using the Omnipod® Insulin Management System with Cloud-Based Data Management

While clinical trials have demonstrated significant benefits of insulin pump therapy for type 1 diabetes, there is increasing recognition of the importance of real-world population data to better understand the impact of diabetes technology on treatment outcomes. This study retrospectively analyzed data from a large cohort of adults with type 1 diabetes using the Omnipod® Insulin Management System (Insulet Corp., Acton, MA) with an integrated BG meter (Abbott Diabetes Care Inc., Alameda, CA) and data management system (Glooko, Mountain View, CA) to characterize glycemic profiles, insulin use and treatment patterns. From January 2015 through September 2018, pump system data were uploaded to the data management system and matched via device serial number to a second database of self-reported demographic data and de-identified. BG and insulin data from ≥3 mo of system use per patient were analyzed. Adults ≥18 y with type 1 diabetes (n=8,020) were age (mean±SD) 40.8±15.3y, 60% female, 61% used a tubeless insulin pump for ≥1 y and 13% used CGM for &amp;gt;50% of overall time of system use. Glycemic profiles included mean glucose 177±39 mg/dL, estimated A1C 7.8%, percent time in target range 70-180 mg/dL, hypoglycemia &amp;lt;70 mg/dL and hyperglycemia &amp;gt;180 mg/dL: 50.2±17.3, 5.9±5.0, and 43.9±18.3, respectively. The total daily insulin was 43.4±18.7 U/d which was delivered as 54% basal and 46% bolus. There were an average of 4.7±2.2 bolus deliveries per day and the average bolus amount was 4.5±2.8 U. These real-world glycemic profiles in adults with type 1 diabetes using the Omnipod® System support the use of diabetes technology in the management of type 1 diabetes. These data indicate that use of a tubeless insulin pump is associated with outcomes that compare favorably to large national registries including the T1D Exchange. Disclosure J.E. Layne: Employee; Self; Insulet Corporation. J. He: Employee; Self; Insulet Corporation. J. Jantz: Employee; Self; Insulet Corporation. Employee; Spouse/Partner; Insulet Corporation. Y. Zheng: Employee; Self; Insulet Corporation. Stock/Shareholder; Self; Insulet Corporation. E. Benjamin: Employee; Self; Insulet Corporation. T.T. Ly: Employee; Self; Insulet Corporation. Funding Insulet Corporation

Terapija insulinskom pumpom u tipu 1 dijabetesa - značaj varijabilnosti glikemije

Terapija insulinskom pumpom u tipu 1 dijabetesa - značaj varijabilnosti glikemije

Efficacy of Insulin Pump Therapy in Type 1 Diabetes Mellitus with a Focus on HbA1c Levels in Relation to Patient Age

Efficacy of Insulin Pump Therapy in Type 1 Diabetes Mellitus with a Focus on HbA1c Levels in Relation to Patient Age

Insulin pump therapy in type 2 diabetes: a consensus pro­posal

Insulin pump therapy in type 2 diabetes: a consensus pro­posal

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

REPOSE: repositioning insulin pump therapy in Type 1 diabetes.

REPOSE: repositioning insulin pump therapy in Type 1 diabetes.

Effect of carbohydrate counting using bolus calculators on glycemic control in type 1 diabetes patients during continuous subcutaneous insulin infusion.

The present study examined the long‐term efficacy of insulin pump therapy for type 1 diabetes patients when carried out using carbohydrate counting with bolus calculators for 1 year. A total of 22 type 1 diabetes patients who had just started continuous subcutaneous insulin infusion were examined and divided into two groups: one that was educated about carbohydrate counting using bolus calculators (n = 14); and another that did not use bolus calculators (n = 8). After 1 year, the hemoglobin A1c levels of the patient group that used bolus calculators decreased persistently and significantly (P = 0.0297), whereas those of the other group did not. The bodyweight, total daily dose of insulin and bolus percentage of both groups did not change. Carbohydrate counting using bolus calculators is necessary to achieve optimal and persistent glycemic control in patients undergoing continuous subcutaneous insulin infusion.

Do We Need Updated Guidelines on the Use of Insulin Pump Therapy in Type 2 Diabetes? A Review of National and International Practice Guidelines.

Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. A literature review was performed to identify published national and international guidelines on type 2 diabetes management. Searches were performed using PubMed, Cochrane Library, and Embase databases, and websites of national health care agencies, reimbursement agencies, and professional associations. Searches were limited to articles published in English between 2004 and 2014 and 1666 unique hits were identified, of which 22 were reviewed following screening. Only 6 of the 22 guidelines identified from North and South America, Western Europe, Greece, and Israel provided specific recommendations on intensive insulin therapy and the role of CSII, and only 1 provided information on the grade of evidence supporting recommendations. Quality appraisal based on the AGREE II tool suggested that published guidelines may have limitations in terms of search methodology and evidence grading, and findings were of mixed rigor and clarity. Only 3 guidelines described the population for whom CSII may be appropriate. Guidelines need to improve the evidence base, rigor, clarity, and grading of evidence associated with recommendations on intensive insulin therapy in type 2 diabetes. Future updates may benefit from considering recent evidence on the efficacy of CSII in poorly controlled patients on MDI.

Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control.

Real-world data regarding indications for use of insulin pump remain sparse. We investigated characteristics among individuals with type 1 diabetes (T1D) in relation to indication for use of insulin pump (CSII). Comparison was made with T1D subjects using multiple daily injections (MDI). We included all individuals with T1D who had at least 1 registration in the National Diabetes Register during 2014-2015. Among 46 874 individuals, we excluded 2350 due to missing data. We examined 35 725 on MDI and 8799 on CSII regarding characteristics in relation to insulin delivery method, as well as association between insulin delivery and glycemic control (HbA1c) and presence of albuminuria. Unadjusted mean (SD) HbA1c was 63.84 (15.07) mmol/mol (7.99 [1.38]%) and 63.75 (13.19) mmol/mol (7.99 [1.21]%) in the MDI and CSII group, respectively. MDI and CSII users were on average 48.8 and 41.5 years old, respectively. MDI users were on average 26 years old and CSII users 17 years old at the time of diabetes diagnosis. Overall, a higher proportion of CSII users were females (53.5%). As compared with MDI, use of CSII was associated with up to 7.84 mmol/mol (0.72%) lower HbA1c in a multivariable adjusted model. Use of CSII was, however, not associated with risk of having albuminuria. CSII was used more frequently in younger individuals, early-onset diabetes, and problematic glycemic control. The use of CSII was associated with lower HbA1c among CSII users except from those who started CSII due to high HbA1c.

The role of insulin pump therapy for type 2 diabetes mellitus.

Many patients with type 2 diabetes fail to achieve adequate glucose control despite escalation of treatment and combinations of multiple therapies including insulin. Patients with long-standing type 2 diabetes often suffer from the combination of severe insulin deficiency in addition to insulin resistance, thereby requiring high doses of insulin delivered in multiple injections to attain adequate glycemic control. Insulin-pump therapy was first introduced in the 1970s as an approach to mimic physiological insulin delivery and attain normal glucose in patients with type 1 diabetes. The recent years have seen an increase in the use of this technology for patients with type 2 diabetes. This article summarizes the clinical studies evaluating insulin pump use in patients with type 2 diabetes and discusses the benefits and shortcomings of pump therapy in this population. Copyright © 2016 John Wiley & Sons, Ltd.

Retinal characteristics during 1year of insulin pump therapy in type 1 diabetes: a prospective, controlled, observational study.

To investigate changes in retinal metabolism, function, structure and morphology in relation to initiation of insulin pump therapy (continuous subcutaneous insulin infusion, CSII). Visual acuity, retinopathy level, dark adaptation kinetics, retinal and subfoveal choroidal thickness, macular perfusion velocities, retinal vessel diameters and blood oxygen saturations were measured at baseline and after 1, 4, 16, 32 and 52weeks in 31 patients with type 1 diabetes who startedCSII and 20 patients who continued multiple daily insulin injections (MDI). One year of CSII reduced haemoglobin A1c (HbA1c ) by 1.6% (17.8mmol/mol) compared with 0.3% (3.1mmol/mol) in the MDI group (p<0.0001). Central retinal thickness increased by 1.5% in the CSII group (within-group p=0.0098; between-group p=0.063) without producing macular oedema. No detectable change was found in any other primary outcome measure. The proportion of patients with retinopathy worsening did not differ between groups. At baseline, longer disease duration was associated with higher retinal artery oxygen saturation (p=0.014) and lower macular venous perfusion velocity (p=0.045). One year of CSII led to an HbA1c reduction relative to continued MDI and a small increase in retinal thickness but not to early retinopathy worsening or to changes in retinal vascular, structural or functional characteristics. Longer duration of type 1 diabetes appears to be associated with lower macular venous perfusion velocity and higher retinal artery oxygen saturation. The latter could potentially reflect cumulative glycaemia.

Introduction of a new health technology into a provincial health system: A case study of insulin pump therapy.

Decisions on the introduction of new non-drug health technologies into healthcare are challenging. This article describes the introduction of insulin pump therapy for type 1 diabetes in Alberta, using an Access with Evidence Development (AED) approach. The organization and implementation of the AED, its current status, and lessons learned are described.

Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study

Aims. To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA1c levels (success) on CSII. Methods. 18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months. Results. Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on CSII in group A compared to group B (0.41 ?0.12 U/kg vs. 0.93?0.6 U/kg respectively, p=0.011). We also noted a trend of weight reduction in the group A vs. weight gain in the group B. Conclusions. CSII is a viable tool in insulin ? requiring type 2 diabetes persons, since the insulin dosing and release it provides are much more physiological. CSII is safe and effective for improving glycemic control, but not in all diabetes patients. We suggest IWR reduction may serve as an early predictor of success on CSII. This work may serve as a "proof-of-concept" study, demonstrating once again the fundamental role of strict weight control in type 2 diabetes. More studies are needed to explore and confirm our experience.

Efficacy and Safety of Insulin Pump Therapy in Type 2 Diabetes: The OpT2mise Study

Efficacy and Safety of Insulin Pump Therapy in Type 2 Diabetes: The OpT2mise Study

Diabetes: insulin pump therapy for type 2 diabetes mellitus.

The evidence base for the efficacy of insulin pump therapy in type 2 diabetes mellitus (T2DM) has been inconsistent to date. However, a recent large-scale randomized controlled trial comparing pump treatment with multiple daily insulin injections in patients with poorly controlled T2DM has shown substantial improvement in glycaemic control with pump therapy.