In October 1998, 16% of CWD readers reported using an insulin pump. Sixteen years later, in September 2016, that number was 74%. Study after study report on the benefits of pump therapy, including a reduced risk of hypoglycemia compared with a regimen of Regular and NPH and better control as evidenced by HbA1c levels. Control is comparable when comparing pump use to a regimen of multiple daily injections of Lantus and NovoLog or Humalog18, but still people choose pump therapy. Why is that?

First and foremost, pump therapy provides an enormous amount of freedom. You have essentially normal schedule freedom. You can eat when you want, not when some long-acting dose of insulin is peaking. (Lantus users experience the same freedom from the long-acting peaks of NPH.) You also have the freedom to eat more often, and in smaller amounts, than you would if you have to take an injection for each and every morsel that you ate. While MDI users could do the same, it could means an enormous number of injections per day. Pump users simply program their pump to deliver an insulin bolus whenever they eat. This has profound implications for quality of life*.

You also have the freedom from injections. Pump users replace their infusion set on average every three days (poll from February 2016), compared with someone who would need to take more than a dozen injections during that same period if on MDI with Lantus or Levemir.

The precision with which pumps can deliver small amounts of insulin cannot be matched by syringes or pens. This gives pump users the ability to cover smaller amounts of food more precisely, and to take tiny extra amounts of insulin to bring down blood sugars that are higher than desired. This flexibility cannot be matched by syringes or pens due to the limits of their dosing accuracy.

Pump users also always have their insulin with them. There’s no “I forgot my insulin” moments when you’re out or at school.

Pump use isn’t for everyone. Some people don’t like the idea of wearing a medical device all the time. Some people would prefer not to spend the extra money on the pump when the same level of glucose control can be achieved with MDI using Lantus (though the schedule and eating freedom is not the same). But for many people, an insulin pump represents the best that medicine and science has to offer today.


References:

  1. Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality. Free full text available in HTML and PDF formats.
  2. Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study.
  3. Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross-sectional cohort study.
  4. Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness (PDF).
  5. Morning Hyperglycemia in Children and Adolescents with Type 1 Diabetes and Different Modes of Therapy: An Evaluation of the DPV Data Pool.
  6. Benefits of subcutaneous continuous insulin infusion in type 1 diabetic patients with high glycemic variability.
  7. Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen.
  8. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment.
  9. Basal Insulin Substitution with Glargine or Continuous Subcutaneous Insulin Infusion in Adult Type 1 Diabetes Patients-A Randomized Controlled Trial.
  10. Sensor-Augmented Insulin-Pump Therapy.
  11. Pilot Study for Assessment of Optimal Frequency for Changing Catheters in Insulin Pump Therapy-Trouble Starts on Day 3.
  12. Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion.
  13. Improvements in cognition, mood and behaviour following commencement of continuous subcutaneous insulin infusion therapy in children with type 1 diabetes mellitus: a pilot study.
  14. Continuous subcutaneous insulin infusion leads to immediate, stable and long-term changes in metabolic control.
  15. In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine.
  16. Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 years.
  17. Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections.
  18. Continuous subcutaneous insulin infusion benefits quality of life in preschool-age children with type 1 diabetes mellitus.
  19. Continuous subcutaneous insulin infusion therapy: effects on quality of life. Free full text available in PDF format.
  20. Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus. The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI).
  21. Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes.
  22. The impact of continuous subcutaneous insulin infusion on health-related quality of life in children and adolescents with type 1 diabetes.
  23. Long-term benefits of continuous subcutaneous insulin infusion in children with Type 1 diabetes: a 4-year follow-up.
  24. Insulin pump therapy in type 1 diabetes mellitus.
  25. Insulin Pump Therapy in Preschool Children with Type 1 Diabetes Mellitus Improves Glycemic Control and Decreases Glucose Excursions and the Risk of Hypoglycemia. Free full text available in PDF format.
  26. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial.
  27. Insulin pump therapy in childhood diabetes-cost implications for Primary Care Trusts.
  28. Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability.
  29. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia.
  30. Continuous subcutaneous insulin infusion in toddlers and children with type 1 diabetes mellitus is safe and effective.
  31. Insulin pump use in young adolescents with type 1 diabetes: a descriptive study.
  32. A Two-Center Randomized Controlled Feasibility Trial of Insulin Pump Therapy in Young Children With Diabetes.
  33. Insulin pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of life.
  34. Insulin Pump Helps Kids With Diabetes.
  35. Persistence of Benefits of Continuous Subcutaneous Insulin Infusion in Very Young Children With Type 1 Diabetes: A Follow-up Report.
  36. Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness
  37. Insulin Pump Therapy: A meta-analysis [Diabetes Care 26:1079-1087, 2003]. Full text available as HTML or PDF.
  38. Safety and Effectiveness of Insulin Pump Therapy in Children and Adolescents With Type 1 Diabetes [Diabetes Care 26:1142-1146, 2003]. Full text available as HTML or PDF.
  39. A Randomized, Controlled Study of Insulin Pump Therapy in Diabetic Toddlers
  40. The cost-effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetes [Diabet Med. 2003 Jul;20(7):586-93].
  41. Metabolic control in young children with type 1 diabetes treated with continuous subcutaneous insulin infusion (insulin pump) [Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2003;9(1):11-5].
  42. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: a randomized open crossover trial [Pediatrics. 2003 Sep;112(3 Pt 1):559-64].
  43. The Insulin Pump in Infants and Young Children
  44. Continuous subcutaneous insulin infusion in diabetes mellitus type 1 and 2: lower HbA1c-values and a high level of patient satisfaction [Ned Tijdschr Geneeskd. 2003 Oct 11;147(41):2021-5].
  45. Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes [J Pediatr. 2003 Dec;143(6):796-801].
  46. A Randomized Trial of Continuous Subcutaneous Insulin Infusion and Intensive Injection Therapy in Type 1 Diabetes for Patients With Long-Standing Poor Glycemic Control [Diabetes Care 25:2074-2080, 2002]. Full text available as HTML or PDF.
  47. Continuous Subcutaneous Insulin Infusion at 25 Years: Evidence base for the expanding use of insulin pump therapy in type 1 diabetes [Diabetes Care 25:593-598, 2002]. Full text available as HTML or PDF.
  48. Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus [J Pediatr. 2002 Oct;141(4):490-5.]
  49. Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years [Diabet Med. 2002 Sep;19(9):746-51].
  50. Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes [Endocr Pract. 2001 Sep-Oct;7(5):364-9].
  51. Pilot Study Indicates Insulin Pump Therapy is Effective for Infants and Preschool Children with Type I Diabetes [Duke University press release from May 6, 2002]
  52. The Business of Insulin Pumps in Diabetes Care: Clinical and Economic Considerations [Clinical Diabetes 20:214-216, 2002].
  53. Glycemic parameters with multiple daily injections using insulin glargine versus insulin pump [Diabetes Technol Ther. 2004 Feb;6(1):9-15].