Insulin pumps are significantly more effective at controlling blood glucose than multiple daily insulin injections in type 2 diabetes patients, according to the largest international study to examine the safety and effectiveness of the devices.
Roughly a third of type 2 patients taking insulin struggle to achieve the right level of blood glucose control with insulin injections many times a day, note the authors of the study in The Lancet.
“Our findings open up a valuable new treatment option for those individuals failing on current injection regimens”
Previous randomised trials comparing the efficacy of insulin pump therapy and multiple injections in people with type 2 diabetes have not provided consistent evidence, they added.
The OpT2mise trial enrolled 495 adults, aged 30-75, with poorly controlled type 2 diabetes to a two month run-in period, where their insulin multiple daily injection treatment was optimised.
After the run-in phase, the 331 participants whose HbA1c remained above the target range (8-12%) were randomly assigned to pump therapy or to continue with multiple injections.
Pumps outperformed multiple daily injections on several measures, said the researchers.
Patients who used the pumps achieved a significantly greater reduction in average HbA1C levels than those who used multiple daily injections at six months – a difference of -0.7%.
Twice as many also reached a target range of 8% or less on pump-therapy compared with the injection group – 55% versus 28%.
Patients using the pump spent almost three hours less every day in hyperglycaemia, while the time spent in hypoglycaemia remained similarly low with pump and multiple daily injections.
At the end of the study, the daily dose of insulin was 20% lower with pump therapy than with multiple injections and no weight difference was observed between the groups.
Lead researcher Professor Yves Reznik, from the University of Caen Côte de Nacre Regional Hospital Center in France, said: “Pumps enhance effective insulin absorption and increase insulin sensitivity thanks to the continuous daily subcutaneous insulin delivery.
“Our findings open up a valuable new treatment option for those individuals failing on current injection regimens and may also provide improved convenience, reducing the burden of dose tracking and scheduling, and decreasing insulin injection omissions.”