DOC News August 1, 2005
Volume 2 Number 8 p. 5
© 2005 American Diabetes Association
Insulin pumps a viable treatment for type 2 diabetes
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Geralyn R. Spollett, MSN, ANP, CDE, is the associate director and an adult
nurse practitioner at Yale Diabetes Center, Yale School of Medicine, in New
Haven, Conn. She is an associate editor of Diabetes Spectrum.
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Dan Dyroff, RN, BSN, CDE, is a diabetes nurse specialist for Medtronic
Diabetes. Previously, he was program manager at the Diabetes Education and
Treatment Center in White Plains, N.Y.
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Question: What is the role of insulin pumps in type 2
diabetes?
Answer: As type 2 diabetes progresses, a patient may require insulin
therapy to maintain optimal glucose control. In the presence of insulin
resistance and the need for intensification of insulin therapy,
ever-increasing amounts of insulin given in multiple dosages may be necessary
to meet target glucose goals. However, the use of intermediate- or long-acting
insulin in combination with rapid- or fast-acting insulin may not address
adequately the glucose levels and excursions associated with type 2 diabetes.
The patient becomes more vulnerable to the side effects associated with
insulin use—weight gain and hypoglycemia.
For patients with type 2 diabetes, an insulin pump (also called continuous
subcutaneous insulin infusion [CSII] therapy) can provide a feasible
alternative to insulin injections.
Insulin pumps, which more closely mimic the way the body delivers insulin,
are both safe and efficacious when used in patients with type 2 diabetes. In a
2003 study comparing multiple daily injection (MDI) to CSII therapy, Philip
Raskin, MD, and colleagues examined efficacy, safety, and patient satisfaction
in a group of 127 subjects with type 2
diabetes.1 The study
was conducted for 24 weeks with subjects randomized to either MDI with
intermediate-acting NPH insulin and rapid-acting insulin aspart (NovoLog, Novo
Nordisk) or CSII using a Medtronic MiniMed 507c pump with NovoLog. The results
showed that glycated hemoglobin (A1C) decreased similarly for both groups, but
the CSII group demonstrated a trend toward lower self-monitored blood glucose
values, with post-breakfast values showing significant improvement.
When the subjects were asked which therapy they preferred, 93% answered
CSII, noting that it interfered less with their life and was more convenient
and less burdensome than multiple daily injections.
Since insulin pumps use only rapid-acting insulin (delivering doses as
small as 0.025 units/hour), the rate and timing of the insulin infusion can be
adjusted to the patient's individual glucose profile. In patients with type 1
diabetes, who are totally dependent on exogenous insulin for glucose
metabolism, the advantages of this therapy for insulin replacement are
clear.
Patients with type 2 diabetes also benefit from the flexibility of pump
therapy and even have some additional advantages. Since insulin is delivered
in a more physiological way, less insulin is needed to achieve glucose
control. Problems with weight gain and hypoglycemia are more easily corrected
with this flexible system. In fact, patients who choose to exercise find they
can reduce the insulin dosage in small increments at specific times for
physical activity and avoid extra snacking to prevent hypoglycemia. Patients
who are trying to lose weight may adjust the pump settings to reflect their
reduction in caloric intake, thereby reducing the tendency to "feed the
insulin."
Insulin pumps have become more user-friendly and are designed with a
menu-driven programming system similar to that used in personal computers.
Even older patients who may be less familiar with this technology find that
after one or two training sessions they feel comfortable with the mechanics or
button-pushing aspects of the
pump.2
As with all successful pump users, CSII candidates with type 2 diabetes
must have the motivation to frequently test glucose levels and the
decision-making skills to adjust therapy based on data. They also need the
confidence to learn and adjust to a new form of diabetes self-management.
Footnotes
References
1. Raskin P, Bode BW, Marks JB, et al.: Continuous subcutaneous
insulin infusion and multiple daily injection therapy are equally effective in
type 2 diabetes. Diabetes Care 26: 2598–2603, 2003.[Abstract/Free Full Text]
2. Roszler J: Senior pumpers: Some seniors may benefit from pump
therapy even more than young people do. Diabetes
Forecast 55:37–40, 2002.
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