Authors:
Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW
Authors notes:
JAMA - Journal of the American Medical Association. 2013;310(12):1240-1247
Keywords:
Diabetes, pump therapy, sensor-augmented insulin pump, hypoglycaemic events
Abstract:
Hypoglycemia is a critical obstacle to the care of patients with type 1 diabetes.
Sensor-augmented insulin pump with automated low-glucose insulin suspension has the potential to reduce the incidence of major hypoglycemic events.
To determine the incidence of severe and moderate hypoglycemia with sensor-augmented pump with low-glucose suspension compared with standard insulin pump therapy.
Of the 95 patients randomized, 49 were assigned to the standard-pump (pump-only) therapy and 46 to the low-glucose suspension group.
The mean age was 18.6 years; duration of diabetes, 11.0 years; and duration of pump therapy, 4.1 years.
The baseline rate of severe and moderate hypoglycemic events in the pump-only group was 20.7 vs 129.6 events per 100 patient months in the low-glucose suspension group.
After 6 months of treatment, the event rates decreased from 28 to 16 in the pump-only group vs 175 to 35 in the low-glucose suspension group.
The adjusted incidence rate per 100 patient-months was 34.2 for the pump-only group vs 9.5 for the low-glucose suspension group.
The incidence rate ratio was 3.6.
There was no change in glycated hemoglobin in either group: mean, 7.4 to 7.4 in the pump-only group vs mean, 7.6 to 7.5 in the low-glucose suspension group.
Counterregulatory hormone responses to hypoglycemia were not changed.
There were no episodes of diabetic ketoacidosis or hyperglycemia with ketosis.
Sensor-augmented pump therapy with automated insulin suspension reduced the combined rate of severe and moderate hypoglycemia in patients with type 1 diabetes.