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New Devices Improve Diabetes Control

Insulin Pump, Shots Equally Effective, but Pump Plus Monitor Is Best

By Salynn Boyles
WebMD Health News

Reviewed by Brunilda Nazario, MD

July 9, 2012 -- By combining insulin pumps with continuous blood sugar sensors, people with diabetes get better blood sugar control than those using finger-stick testing and insulin shots, new research suggests.

The findings come from an analysis of studies comparing new technologies to traditional methods for monitoring and controlling blood sugar.

The studies find that old-fashioned insulin injections control blood sugar just as well as insulin pumps. But most studies find that people get better results by combining the pumps with new blood sugar-monitoring devices.

New Technologies, Better Outcomes?

Patients who used continuous glucose monitors to automatically track blood sugar had better blood sugar levels than people who used finger stick testing alone. However, the two methods were equally effective at keeping blood sugar from dropping to dangerously low levels.

Insulin pumps were no more effective for controlling blood sugar than self injection in most studies, but people tended to prefer the pumps over giving themselves shots many times a day.

And people who used insulin pumps with coordinated, real-time continuous monitoring devices achieved better blood sugar control than people who use finger-stick testing and shots alone.

"When we compared the new to the old, we saw a much greater improvement in glucose control when the newer devices were used together," study author Sherita Hill Golden, MD, MHS, of Baltimore's Johns Hopkins University School of Medicine, tells WebMD.

More Options for People With Insulin-Dependent Diabetes

About 26 million Americans have diabetes, in which the body fails to produce enough insulin to control the amount of sugar in the blood.

All people with type 1 diabetes and many people with type 2 disease require treatment with insulin to control blood sugar and reduce the risks of complications, including blindness, heart disease, and nerve damage leading to amputation.

New technologies have given people with diabetes who use insulin more options to manage their disease, but it has not been clear whether this new, more expensive technology truly improves people's health.

"Health professionals and their diabetic patients need objective information when making decisions about use of these technologies that may be expensive or heavily marketed," Golden and colleagues write in the July 10 issue of the journal Annals of Internal Medicine.

Their analysis included data from 33 trials comparing continuous glucose monitoring with insulin pumps to conventional ways of monitoring and controlling blood sugar levels in children, teens, and adults.

Insulin Pumps, Glucose Monitors

Continuous monitoring devices give blood sugar readings as often as every five minutes, using a sensor attached to the body. The sensor sends results to a display, which is usually worn on a belt.

The device doesn't replace home glucose monitoring but can more closely track minute-to-minute changes in blood glucose. Patients still need to prick their fingers up to four times a day, but those who rely on finger pricks alone may need to stick themselves as many as 10 times a day.

Insulin pumps offer continuous insulin through a catheter placed under the skin around the belly. The pump replaces daily injections, although patients still have to make decisions about how much insulin they need.

The analysis found that insulin pumps and daily injection are similarly effective for controlling blood sugar, leading the researchers to conclude that decisions about which method to choose should include consideration of patient preference and quality of life.

Diabetes specialist Stuart Weinerman, MD, says some of his patients love the new devices while others don't.

Weinerman is an endocrinologist at the North Shore University/Long Island Jewish Medical Center in New Hyde Park, N.Y.

"Some people can't stand the idea of wearing a device all the time, whether it is a pump or a glucose monitor," Weinerman tells WebMD. "Others love the high-tech nature of the new devices and the fact that they have a lot more flexibility."

SOURCES: Hsin-Chieh, Y. Annals of Internal Medicine, July, 10, 2012. Sherita Hill Golden, MD, department of medicine and epidemiology, Johns Hopkins University, Baltimore, Md. Stuart Weinerman, MD, division of endocrinology, North Shore University Hospital/Long Island Jewish Medical Center, New Hyde Park, N.Y. News release, Johns Hopkins Medicine.

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