Type 1 diabetes

Evidence justifies more funding for insulin pumps: expert

More public funding of insulin pumps is justified by new research showing they lower the risk of complications in young people with type 1 diabetes.

Professor Maria Craig, paediatric endocrinologist from the Children’s Hospital at Westmead, told the limbic that a large number of people with diabetes were missing out on the benefits of pump therapy due to their high cost.

“Certainly there is emerging data that shows pumps offer an incremental benefit over and above an MDI regimen. A study like this is good to encourage government funding.”

The European study of more than 30,000 patients across 446 centres found a lower risk of diabetic ketoacidosis and severe hypoglycaemia in patients using pumps compared to insulin injections.

Event rates were significantly lower with pump therapy compared with injection therapy for severe hypoglycaemia (10.30 v 15.53 per 100 patient years), hypoglycaemic coma (2.26 v 3.43), ketoacidosis (4.66 v 6.94) and severe ketoacidosis (3.17 v 5.17).

The same association was found in a propensity-score matched sub-group of almost 20,000 patients.

Pump therapy versus injection therapy was associated with significantly lower rates of severe hypoglycaemia (9.55 v 13.97 per 100 patient-years) and ketoacidosis (3.64 v 4.26).

Patients using pump therapy also had lower HbA1c levels than patients using an injection regimen (8.04 v 8.22%).

Professor Craig said the study supported other evidence from smaller studies for the benefits of pump therapy.

“The strength of this study is that it is population-based, has very large numbers, is generalisable and robust. This is an important study arguing for funding for pumps because of the clinically significant reduction in severe hypoglycaemia.”

She said there were some concerns that pump users, without the protection of basal, long acting insulin, might progress quickly to ketoacidosis if, for example, their pump disconnected.

“What this says is very reassuring in that there’s a slight reduction in the risk of diabetic ketoacidosis in the matched groups and it was more significant in the entire cohort.”

A sub-group analyses by age found the lower rate of hypoglycaemic events was particularly evident in school-aged children while the lower rate of ketoacidosis was evidence in adolescents and young adults.

“It’s reassuring as adolescents are often the ones who aren’t as adherent to their therapy, test less and often have higher HbA1c,” Professor Craig said.

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