Islets of Hope treatment options for persons with diabetes - insulin pumps

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Insulin Pump Therapy
Insulin Pump Studies for the Years 2000 Through 2005

Insulin Pump Studies - 2006
Insulin Pump Studies - 2007


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.

Study Year

2005     *     2004     *     2003     *     2002     *     2001     *     2000   *   1996


  Howard Wolpert
Smart Pumping
:  The insulin pump has opened a whole new world for people with diabetes­­more flexibility in what and when they eat and better blood sugar control, too.  Smart Pumping integrates this new successful technology with the physical and psychological aspects of diabetes care, and helps patients adopt the insulin pump into their self-care regime. This book combines a comprehensive medical approach toward intensive diabetes management and pump therapy with a patient-centered appreciation of the real-life challenges and frustrations.

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.  
  IOH Rating 5/5 

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.

Diabetes Monitor:  Commentary on the DCCT

Implications of the DCCT - A position statement from the American Diabetes Association

The DCCT - National Institute of Diabetes and Digestive and Kidney Disease/NIH


   John Walsh
Pumping Insulin:
 This is a must-read book for anyone on the pump or considering using one.  The information is exhuastive and straightforward.  Even if you think you know it all about pumping, this book will teach you even more!

"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
(Conclusion Provided)

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. ralemzad@mcw.edu

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. klow@bates.edu

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.

   


  Gary Scheiner
Insulin Pump Therapy Demystified
:
 Increasing numbers of people with type 1 diabetes, all of whose lives depend on insulin, as well as type 2 diabetics, have already adopted the insulin pump, which replaces a regimen of insulin shots with a continuous delivery of insulin. Yet many who stand to benefit from "the pump" are put off by not fully understanding the device, and many already using it don’t have anyone with whom to compare notes about its use. Now Gabrielle Kaplan-Mayer, who has used the pump for more than three years, cuts through common personal fears about the pump and offers insight into the day-to-day challenges—and rewards—of life with it. Drawing on interviews with more than seventy-five pump users, including Nicole Johnson, Miss America 1999, as well as diabetes experts and other health professionals, Kaplan-Mayer discusses how the pump affects your sex life, dealing with money issues, finding support, counting carbohydrates, and much more. Insulin Pump Therapy Demystified offers knowledgeable, informative, reassuring advice that all pump users—current and future—will find extremely valuable. Charts and tables add to this valuable insider's guide.

2004 - Insulin Pump Studies
(Conclusion Provided)

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. sara.mcmahon@health.wa.gov.au

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."

Persistence 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. stuart.weinzimer@yale.edu

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. raheptul@texaschildrenhospital.org

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.

Conclusions:

  • Medtronic Insulin Pumps significantly improved A1Cs (from 8.1% to 7.2%), while patients using MDI with Lantus showed no significant change
  • The ADA recommends an A1C target of 7% or below. Six times as many Medtronic insulin pump patients met this target as opposed to patients using the Lantus therapy
  • Insulin pump patients achieved much better blood sugar control before lunch, dinner and at bedtime than those using MDI with Lantus
  • The majority of MDI with Lantus patients, 75%, discontinued MDI therapy and switched to insulin pump therapy after the study

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."

   


  Karen Bolderman
Putting Your Patients on an Insulin Pump
:  Help your patients live a more flexible lifestyle with step-by-step advice on insulin pump therapy from dietitian and diabetes educator Karen Bolderman. Bolderman has spent more than 25 years training and managing hundreds of insulin pump patients with all brands of insulin pumps. Benefit from her "best of" advice, including pros and cons and complete troubleshooting techniques. Chapters cover such topics as:

  • Profiles of good candidates
  • Selecting a pump
  • Carbohydrate counting and managing hyperglycemia
  • Determining starting basal rate--and much more.
  • Plus, practical pump tips for patients, case studies, and success stories.

2003 - Insulin Pump Studies

Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes. (7 December 2003)

Are analogue insulins better than soluble in continuous subcutaneous insulin infusion? Results of a meta-analysis. (2 November 2003)

Safety and Effectiveness of Insulin Pump Therapy in Children and Adolescents With Type 1 Diabetes. (30 March 2003)

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)

   


 Kaughfman/Halverson/Lorey
Putting Your Diabetes on the Pump:
Putting Your Diabetes on the Pump is 64 pages of essential information on using an insulin pump for better blood sugar control. It includes the pros and cons of using a pump, medical guidelines, insulin to carbohydrate ratios, and the skills and personality traits necessary for successful pump use. Plus, real-life advice from a person who has used an insulin pump for several years.

2002 - Insulin Pump Studies

Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus. (20 October 2002)

Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetes.) (13 September 2002)

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)

Efficacy, safety, and pump compatibility of insulin aspart used in continuous subcutaneous insulin infusion therapy in patients with type 1 diabetes. (7 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
Outsmarting Diabetes:
This  aggressive approach to keeping blood sugar readings  at a more constant level is easier to accomplish with the aid of an insulin pump.  If you are up to the (rewarding) challenge of tight control this is a decent book to start with.  The benefits of tight control are not contested, but sadly, 85% of all those diagnosed with diabetes do not adequaltey control their diabetes.

2001 - Insulin Pump Studies

A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump. (18 November 2001)

Intensive Insulin Therapy With Insulin Lispro: A randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection.

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)

Pump Therapy for Children: Weighing the Risks and Benefits -- View 1: The Cons of Insulin Pump Therapy in the Young Child. (17 June 2001)

Pump Therapy for Children: Weighing the Risks and Benefits -- View 2: Insulin Pump Therapy in Young Children With Diabetes. (17 June 2001)

Study finds pump therapy improves control even for patients doing well with multiple daily injections. (21 January 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)

Efficacy of insulin pump therapy: mealtime delivery is the key factor (May/June 2000)

Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes.  (May 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)


Related Information

Insulin Pump Therapy
Insulin Pump, Support, Resource & Information Sites
Insulin Pumps Available
Insulin Pump Tips
Insulin Pump-Friendly Doctors
Health Insurance Laws
Health Insurance and Aid Programs for Diabetics

   

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Page Updated 07/24/2007