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Question:

From Boston, Massachusetts, USA:

Are there any studies that look at pumping versus multiple daily injections for overall control? I want to do the best for my daughter, but have been steered toward the pump out of convenience. Is there anything that weighs the two options as a better treatment plan? I'm really interested in seeing the long term results of both types of treatment. I don't want to make a decision about pumping on the convenience factor. I really want it to be an evidence based practice choice. For now, my daughter gets Lantus in the morning (because she has gone low at night) and Humalog for meals. We are still working on her ratios as she is newly diagnosed.

Answer:

There are multiple studies. You can go to PubMed and read them yourself if you want the originals. Compared to Lantus with MDI Humalog or Levemir with MDI NovoLog, A1cs of pumpers are about the same or 0.5% better across the board - pediatrics, adolescents, adults. Also, there seems to be less hypoglycemia, but not in all studies. Quality of life self-ratings also seem to improve on the pump versus MDI. The best current pediatric studies are those of Diess et al in Germany, Weinzimer/Gray/Tamborlane et al at Yale, Philips et al in Israel; those centers' investigators names will come up on the PubMed search. We currently have about 35% of our pediatric patients using pumps successfully with major reasons for switching to pump being avoiding nocturnal hypoglycemia, improving glycemic variability and excursions and lowering A1c values towards a target of less than 7% safely. Pump use is steadily increasing in U.S. and European centers for similar reasons. However, pump use is more labor intensive, still requires parental supervision and monitoring/logbook analysis or computer downloading analysis, still requires a meal plan and attention to carbohydrate counting, activity adjustment, etc.

SB

DTQ-20080214010625
Original posting 18 Feb 2008
Posted to Daily Care and Insulin Pumps

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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