Drug & Device Development
Sensor-augmented insulin pump improves glycemic control
NEW YORK (Reuters Health) – Patients with type 1 diabetes improved their glycemic control by switching from multiple daily insulin injections to sensor-augmented pump (SAP) therapy, in a recent study.
This was true even for patients whose injection regimens had been optimized for a year before the switch.
The findings are an extension phase of the randomized STAR 3 trial. Last year in the New England Journal of Medicine, the research team had reported great reductions in A1C levels at 12 months with SAP than with multiple daily injection therapy.
In an optional continuation phase, reported online September 20th in Diabetes Care, 204 patients in the SAP group continue on the device, and 190 patients in the optimized injection group switched over to SAP.
Six months later, according to Dr. Richard M. Bergenstal from International Diabetes Center at Park Nicollet, Minneapolis, Minnesota and colleagues, patients who had switched from multiple daily injection therapy to SAP therapy had significant reductions in A1C, from 8.0% at the switchover (i.e., at 12 months) to 7.6% at 15 to 18 months.
Improvements were seen in both adult and pediatric groups.
Patients in the crossover group with the biggest improvements were those who wore the continuous glucose monitoring sensor more than 60% of the time.
Patients in the original SAP group maintained the improvements in A1C levels they achieved in the first year of treatment if they used their sensors more than 40% of the time. Glycemic control deteriorated slightly in patients who used sensors less frequently, according to the researchers.
Sensor wear times were significantly greater among adults (61%) than among children (45%).
Severe hypoglycemia rates did not differ significantly between the original SAP group and the group that crossed over to SAP, according to the report.
”Switching from optimized multiple daily injection to SAP therapy allowed for rapid and safe A1C reductions,” the researchers conclude.
Also, they add, ”Glycemic benefits of SAP therapy persist for at least 18 months.”
”Work continues toward the integration of SAP platforms and controller algorithms that can safely reduce hypoglycemic exposure and may someday provide fully closed-loop insulin delivery,” they add.
Some researchers have suggested that based on STAR 3 data, SAP therapy may not be cost-effective in most scenarios, but cost-effectiveness could improve significantly with technological advances currently in development.
Diabetes Care 2011 Oct.
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www red DiabetologNytt
Publicerad: |2011-10-05|