With a new advanced insulin pump, patients with type 1 diabetes had more even blood sugar at a better level than before. Researchers at the University of Gothenburg saw this in a study where they evaluated the latest generation of insulin pumps in 142 people at six clinics.
The study is published in Journal of diabetes science and technology.
Advanced insulin pump doses
In type 1 diabetes, the body’s own insulin production ceases and the patient needs insulin treatment. It can take place in several different ways. The most common today is to have a glucose meter implanted under the skin and use this to dose insulin yourself.
You can do by taking injections with insulin pens. Another option is to have a small pump that continuously delivers insulin into the subcutaneous fat. It is still the patient himself who controls the dosage based on readings from the glucose meter.
But there is also a new type of advanced insulin pump that both measures the blood sugar level continuously and automatically doses insulin so that the blood sugar level is kept under control. It takes place around the clock via a tube connected to a thin cannula in the subcutaneous fat. In certain situations, the person must also control this pump themselves, for example in connection with meals.
Knowledge gaps need to be filled
The new technology is called advanced hybrid closed loop, AHCL. In Sweden, such AHCL pumps have been available in recent years. However, knowledge of how they affect the treatment of type 1 diabetes is still limited. This was stated by the Västra Götaland region’s center for the evaluation of health technology in a report last year.
It still exists too few well-conducted studies to be able to make a definite statement about the advantages and disadvantages of the new pumps and evaluate how cost-effective they are.
The Gothenburg researchers behind the current study want to improve the state of knowledge. They randomly selected 142 adult participants who had received treatment with an AHCL pump. The researchers studied the participants’ blood sugar levels during this treatment and compared them with the levels before.
Gives better blood sugar control
The study participants were on average 42 years old, and had had their AHCL pump for just over a year and a half on average. The study showed that patients had a clear improvement in blood sugar with the new pump.
The goal of insulin therapy is to keep the blood sugar level and within the limits of 3.9 and 10 mmol/L. On average, patients’ time with a blood sugar within this range increased by about three and a half hours per day when they had an AHCL pump.
Before the pump was inserted, blood sugar was within the limits below on average 57 percent of the time. With the new pump, that increased to 71.5 percent of the time.
Reduced risk of organ damage
The doctor Ramanjit Singh is a researcher at the University of Gothenburg and lead author of the study:
– It is a strong improvement that patients on average increase their time in the target area by as much as three and a half hours. Guidelines consider that improvements of approximately one hour within the target area have an important meaning in reducing the risk of organ damage, she says in a press release.
Participants were also generally very satisfied with their advanced insulin pump, according to survey responses included in the study. On a scale from minus 18 (worst) to plus 18 (best), the average result was plus 14.8.
Side effects and safety
Severe drops in blood sugar (due to too much insulin) occurred on a total of four occasions during the study. According to the researchers, this was no change compared to when the patients had other treatment.
No falls off the condition of ketoacidosis (due to insulin deficiency) occurred.
But there was one side effect that was very common. Almost a third of the patients developed skin problems from the adhesive used in the dressings for insulin pumps and associated glucose meters.
Hope for further improvements
Marcus Lind, professor of diabetology at Sahlgrenska Academy at the University of Gothenburg, leads the research unit for diabetes at Sahlgrenska University Hospital Östra, where the research was carried out.
– We believe that blood sugar levels will improve further as more patients receive the new treatment. This will lead to reduced organ damage and a better prognosis, he says in the press release.
– Development of more tolerable products for the skin is important together with the treatment and further larger studies to assess the safety of the treatment are of value, says Marcus Lind.
The study was a academic study and not sponsored by companies that manufacture AHCL pumps.
