News ID: 202204
Published: 1011 GMT October 11, 2017

Pump may beat shots for type one diabetes

Pump may beat shots for type one diabetes
healthday.com

In young people with type one diabetes, insulin pump therapy may offer better blood sugar control and fewer complications than daily injections of the vital hormone, new German research suggested.

Dr. Robert Rapaport, chief of the division of pediatric endocrinology at the Icahn School of Medicine at Mount Sinai in New York City said, "Insulin pumps work, and they work even somewhat better than multiple daily injections overall.”

According to UPI, Dr. Siham Accacha, a pediatric endocrinologist at NYU Winthrop Hospital in Mineola, N.Y., explained why that might be so.

"If the pump is really taken care of, you can micromanage your diabetes," she said.

"You can stop the pump if your blood glucose is coming down, or you can give a bit more insulin if it's going up."

Both Rapaport and Accacha prefer pump use, but if patients would rather do multiple daily injections, the doctors said that excellent control can also be maintained with shots. It's really a matter of patient preference, they noted.

One issue with the pump is price. The start-up cost for a pump can be as much as $5,000, according to Accacha. And there are monthly costs for supplies as well. Insurers, especially Medicaid, sometimes hesitate to pay, both experts said. But studies like this latest one help provide more evidence about the importance of pump therapy.

"Pumps are more expensive, but I don't think expense should guide quality of therapy," Rapaport said.

"Even though pumps are more expensive, they lead to better results and less complications, so health care costs will even out."

Plus, Accacha said, "It helps to make kids with diabetes feel more like other kids, and makes them feel a little bit more normal."

Type one diabetes patients don't make enough insulin, a hormone that helps carry the sugar from foods into the body's cells to be used as fuel.

To replace that lost insulin, patients must either take multiple daily insulin injections or get insulin via a tiny tube inserted temporarily under the skin and attached to an insulin pump.

No matter which delivery system a person chooses, getting the dose of insulin right remains a difficult balancing act. Too much insulin can send blood sugar levels dangerously low, which can cause hypoglycemia. Initially, hypoglycemia causes dizziness, a racing heart, sweating and confusion, according to JDRF (formerly the Juvenile Diabetes Research Foundation). Left untreated, hypoglycemia can cause fainting or seizures. Severe hypoglycemia can cause death.

Too little insulin causes blood sugar levels to rise. This can cause fatigue, dry mouth, blurry vision and stomach pain. If blood sugar stays too high too long, a complication called diabetic ketoacidosis (DKA) can occur, according to JDRF.

This means the body uses fat and body tissue for fuel. This produces toxic acids called ketones. If these are allowed to build up, a diabetic coma can result and possibly lead to death.

If blood sugar levels are high, but not high enough to cause DKA, they can contribute to complications in the long run, such as heart disease, serious vision problems and kidney disease.

The new study looked at the rates of severe hypoglycemia and DKA, as well as overall blood sugar levels in people aged 20 and younger who used either an insulin pump or multiple daily injections.

The children and teens came from 446 diabetes centers in Germany, Austria and Luxembourg. The initial study group included just over 30,000 people with a mean age of 14. The final matched comparison groups included almost 10,000 people on insulin pumps versus 10,000 on shots.

The researchers, led by Drs. Joachim Rosenbauer and Reinhard Holl of the German Center for Diabetes Research in Neuherberg, saw a slight improvement in blood sugar control for those on pump therapy over a year of treatment.

Children and teens on pumps were less likely to experience severe hypoglycemia and DKA than those on shots.

Rapaport noted that the improvement in DKA wasn't in all age groups. For example, in kids aged one to five, there was no difference.

"But, there was a major difference in adolescents, and that would be very important," he said.

   
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