Train more nurses in use of insulin pumps, says diabetes charity
A charity has called for more specialist nurses to be trained in supporting patients use insulin pumps after evidence suggested they are more effective at controlling blood glucose than insulin injections in children with type 1 diabetes and cause fewer complications.
The Australian research, published online in the journal Diabetologia, is the longest and largest study to date of the effectiveness of insulin pumps to treat type 1 diabetes in children.
A total of 345 patients on pump therapy were matched to controls on injections. Subjects had a mean age of 11 years and had diabetes for around four years.
The mean difference in HbA1c between the pump and non-pump cohort was 0.6% (6.6mmol/mol) over seven years of follow-up.
Pump therapy reduced episodes of severe hypoglycaemia from 14.7 to 7.2 events per 100 patients per year. In contrast, severe hypoglycaemia increased in the non-pump cohort from 6.8 to 10.2 events per 100 patients per year.
The rate of admission for diabetic ketoacidosis was lower in the pump cohort than in the non-pump cohort – 2.3 vs 4.7 per 100 patients per year – during follow up.
The authors noted that 38 patients ceased pump therapy during the study.
Some children stopped because they became tired of the extra attention needed to manage the pump or were concerned about the physical sight of it. Other children took a temporary ‘pump holiday’ and then recommenced its use.
The authors said: “This is the largest study of insulin pump use in children. It also has the longest follow up period of any study of insulin pump therapy in children.
“Our data confirm that insulin pump therapy provides an improvement in glycaemic control which is sustained for at least seven years.”
Bridget Turner, director of policy and care improvement for Diabetes UK, said: “This provides further evidence that using insulin pumps can help children with type 1 diabetes achieve good blood glucose control and, with the right education and specialist nursing support, in the long term this can help reduce risk of serious complications such as amputation, blindness and kidney failure.
“This is why it is a real concern that the UK is lagging behind comparable countries in terms of insulin pump usage. We want the NHS to do more to ensure there are enough healthcare professionals who are qualified to support children and adults with type 1 diabetes to use a pump effectively.”
- Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study