Insulin pumps improve diabetes control

Continuous insulin infusion delivered by a portable infusion pump allows young people with type 1 diabetes (insulin-dependent diabetes) to maintain better control of their blood sugar levels than is possible with multiple daily injections of insulin. Researchers from the Schneider Children's Medical Center, Israel, analysed glucose control and adverse events in 279 patients ranging from toddlers to young adults who switched to insulin pump therapy. The main measure was the change in glycosylated haemoglobin, commonly referred to as HbA1c. The percentage of haemoglobin that has glucose attached (HbA1c) gives a picture of how well glucose levels in the blood have been regulated over the preceding 2 months. Since HbA1c concentrations are typically about 5 to 8 percent, a change of around half a percent is quite substantial. It was found that HbA1c levels improved by 0.51 percent for the entire group of patients after switching to the insulin pump. The improvement was seen in all groups, including pre-pubertal youngsters (0.48 percent improvement), adolescents (0.26 percent improvement), and young adults (0.76 percent improvement). HbA1c levels continued to fall with increasing duration of infusion up to 3 years, after which there was no significant decrease in HbA1c. Episodes of excessively low blood sugar levels, which can be dangerous, decreased significantly in the adolescent and young adult groups. Continuous subcutaneous insulin infusion improves blood glucose control in children and adolescents with type 1 diabetes, especially those with a history of moderate to poor glycaemic control. This improvement is achieved without a significant increase in major catheter-site infection, or weight gain. In India, though insulin pumps are available, but are expensive – costing about Rs. 1 to 2 lakhs for the equipment and Rs. 6000 to 7000 for the insulin and other disposables.