Islets of Hope treatment options for persons with diabetes - insulin pumps
Insulin Pump Therapy
The news is coming in and it's good... insulin pump therapy is safe and effective even for infants and young children! It is important that patients selected for pump use be ideal candidates. Not everyone is well-suited for pump use. But when good candidates are educated and matched with the pump that best fits their needs, study after study conclude that insulin pump is safe, effective, and has a positive impact on quality of life ... something else that also contributes to improved glycemic control.
Howard Wolpert, M.D., is an instructor in medicine at the Harvard
Medical School Joslin Diabetes Center and is also in charge of the pump clinic
there. He has written extensively on the use of insulin pumps.
Insulin Pump Studies & Information Links
IPump.org - List of studies that support intensive insulin therapy via an insulin pump for the treatment of type 1 diabetes in children.
The Diabetes Control and Complications Trial (DCCT)
Summary of The Diabetes Control and Complications Trial. This summary is an easy-to-read review of the DCCT contains valuable information that can be used for letters to insurance companies to support your interest (and need) for an insulin pump.
Implications of the DCCT - A position statement from the American Diabetes Association
The DCCT - National Institute of Diabetes and Digestive and Kidney Disease/NIH
"As a young Internist, this book proved to be essential in my understanding of diabetes. Searching through my more commonly used references to include Internal Medicine and Endocrinology Textbooks I was unable to find a concise summary of the information and recommendations necessary to manage my patients with pumps. The 500 rule and the 1800 rule were just vague concepts found in obscure management articles and discussions with other providers. I did not have the benefit of a certified pump trainer or diabetic nurse educator. But with this reference as a guide I was able to develop a management plan. In 3 short months I dropped my patient from a HgBA1C of 9.4 to 6.3. Where there were previous highs in the 400's there are just now slight deviations from desired values. This reference and the bolus wizard on the Medtronic pump is all that one needs to demystify the management. And of course you and your patient needs to be motivated and dedicated. Dr. Daniel Carlson, Germany" IOH Rating 5/5
2005 - Insulin Pump Studies
Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. (25 September 2005). Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel.
CONCLUSIONS: We found no advantage for subjects with either PO or PF during exercise, and we noted that late hypoglycemia was more common than hypoglycemia during exercise. However, PO was associated with a trend of increased risk for late hypoglycemia. We recommend that the pump be removed or turned off during prolonged exercise and that blood glucose concentrations be monitored for several hours after exercise, regardless of the pump mode.
Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes. (25 September 2005). Children's Hospital of Wisconsin Diabetes Center, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. email@example.com
CONCLUSIONS: The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions, implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality.
Continuous subcutaneous insulin infusion in toddlers and children with type 1 diabetes mellitus is safe and effective. (27 March 2005). Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY 14642, USA.
CONCLUSIONS: This study supports CSII as a safe and effective alternative to managing T1DM, with no increase in hypoglycemia and a trend to improve control, even in the youngest patients.
Insulin pump use in young adolescents with type 1 diabetes: a descriptive study. (27 March 2005). Department of Psychology, Bates College, Lewiston, ME 04240, USA. firstname.lastname@example.org
Conclusions: To optimize glycemic control, CSII can be initiated and used effectively, both in children of all ages and in adolescents with type 1 diabetes. CSII may be ideal therapy for toddlers, with no apparent lower age boundary for initiating CSII; however, the parenting challenges and requirements for supportive education differ between toddlers and adolescents. When disease and pump management are appropriately individualized, CSII therapy can help children with diabetes achieve and sustain glycemic control. Lifestyle flexibility, quality-of-life improvement, and independence can thus begin early in childhood and be maintained throughout young adulthood.
Flexible Insulin Therapy Works for Preschoolers, Too. Reported on Diabetes Channel, 05/05/2005.
2004 - Insulin Pump Studies
A Two-Center Randomized Controlled Feasibility Trial of Insulin Pump Therapy in Young Children With Diabetes. (26 December 2004). Divisions of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California and University of California, San Francisco, California
RESULTS—The 19 subjects’ ages ranged from 1.7 to 6.1 (mean 3.6) years, duration of diabetes ranged from 0.6 to 2.6 (mean 1.4) years, and baseline HbA1c ranged from 6.7 to 9.6% (mean 7.9%). Seven subjects were male. Nine subjects were randomized to start CSII and 10 to continue on MDI. All baseline characteristics were well balanced. Overall metabolic control, diabetes quality of life, and the incidence of hypoglycemia were similar in the two groups. No subject had diabetic ketoacidosis, while one subject in each group had an episode of severe hypoglycemia. No CSII subject discontinued using the pump during or after the study.
CONCLUSIONS—CSII can be a safe and effective method to deliver insulin in young children
Insulin pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of life. (26 December 2004). Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth 6840, Australia. email@example.com
CONCLUSIONS: Pump therapy is proving an effective means of insulin therapy in the young patient that shows promise to improve glycaemic control with a reduction in hypoglycaemia frequency. Quality of Life measures suggest that psychosocial outcomes may be improved.
Insulin Pump Helps Kids With Diabetes. (12 December 2004). "Dec. 6, 2004 -- Insulin pump therapy may be a safe and effective treatment for children under age 7 with type 1 diabetes, according to a new study."
of Benefits of Continuous Subcutaneous Insulin Infusion in Very Young Children
With Type 1 Diabetes: A Follow-up Report. (5 December 2004). Department of Pediatrics, Yale University School of Medicine, PO Box 208064, 333
Cedar St, New Haven, Connecticut 06520, USA. firstname.lastname@example.org
CONCLUSIONS: CSII is a durable and effective means of optimizing glycemic control in very young patients with type 1 diabetes and may be superior to multiple daily injections in minimizing the risk of severe hypoglycemia in this age group. Employment of paid caregivers does not preclude safe and effective use of CSII.
Continuous glucose monitoring in children with type 1 diabetes: before and after insulin pump therapy. (11 April 2004). Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030-2399, USA. email@example.com
CONCLUSIONS: Pump therapy specifically improved the postprandial glucose excursions in children.
Medtronic MiniMed insulin pumps provide significantly better blood sugar control than MDI with Lantus® in kids and young adults. Doyle (Boland) EA, Weinzimer SA, Steffen AT, et al. A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injection using insulin glargine. Diabetes Care. 2004;27:1554-8.
The study's Lead Investigator, Elizabeth (Boland) Doyle, says:
"We have long known that insulin pumps improve glycemic control in both adults and children. Now a definitive study indicates that insulin pumps more effectively control blood sugar than multiple daily injections using Lantus in young patients," said Elizabeth (Boland) Doyle, MSN, APRN, CDE, Yale School of Medicine. "Pump therapy allows for more immediate and precise fine tuning of insulin dosages that is not possible with injection therapy. We believe this is one of the main reasons why pump therapy has been so successful in pediatric patients. Furthermore, the lifestyle flexibility pumps provide makes it easier for patients living with diabetes."
2003 - Insulin Pump Studies
Hypoglycemia Prevalence in Prepubertal Children With Type 1 Diabetes on Standard Insulin Regimen: Use of Continuous Glucose Monitoring System. This study shows concludes that the "Use of standard insulin regimens results in high prevalence and large intraindividual variation in hypoglycemia, particularly at night," which should provide sufficient motivation for doctors to prescribe pumps. (2 March 2003)
2002 - Insulin Pump Studies
Two posters presented during the 2003 ADA Scientific Sessions indicated that pump users can take a "pump vacation" by using Lantus and NovoLog or Lantus and Humalog and maintain the same level of control. (July 2003)
Metabolic decompensation in pump users due to lispro insulin precipitation. Also in PDF format. (26 May 2002)
Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. (24 March 2002)
Richard S. Beaser
2001 - Insulin Pump Studies
The Supplement: New horizons in insulin pump therapy from Practical Diabetes International includes many excellent articles and letters, including Insulin pumps in children and adolescents by Dr. Ragnar Hanas and Psychological aspects of pumps and patient selection by Dr. Cathy Lloyd. (19 August 2001)
Czech study confirms benefits of insulin pump therapy. (15 July 2001)
Is an Insulin Pump Right for Your Child and Family? (17 June 2001)
2000 - Insulin Pump Studies
Case Study: Use of an Insulin Pump in an Adolescent concludes that pump therapy "... can be a very helpful and safe tool in achieving better glycemic control in the adolescent population." (3 December 2000)
1996 - Insulin Pump Studies
Implantable insulin pump vs multiple-dose insulin for non-insulin-dependent diabetes mellitus: a randomized clinical trial. Department of Veterans Affairs Implantable Insulin Pump Study Group. (October 1996)
Insulin Pump Therapy
Page Updated 07/24/2007