Some tout insulin pump technology as the gold standard when it comes to managing type 1 diabetes. In fact, pump technology allows users to dose insulin in very precise increments, and users can also quickly adjust their basal insulin rates in response to various events like exercise, illness, etc. Many users in the diabetes online community remark that pump technology affords them better blood glucose management and improves their quality of life.

Is this the case for everyone? In a word, no.

Some time ago, our editorial director Allison Caggia shared her compelling commentary in a post titled Five Reasons Why I Choose Multiple Daily Injections, showcasing some common reasons why some may hesitate to even try the pump and why insulin pump therapy is not the right choice for everyone.

When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results.

Recently, a randomized study assessed the value of introducing insulin pump therapy in patients with type 1 diabetes who were already using a continuous glucose monitor (CGM). This research was conducted as part of the second phase of the DIAMOND (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes) study, and the results were published in the journal Medical Decision Making earlier this month.

Study Design

A total of 75 participants with type 1 diabetes who were already using CGM technology were randomly assigned to insulin pump vs. multiple daily injection (MDI) therapy. Clinical and other parameters were assessed at baseline and after 28 weeks, at the conclusion of the study. The study authors assessed the effects on blood glucose control, quality of life measures, and also cost-effectiveness of initiating pump therapy.

Pump Therapy Is More Expensive

Not surprisingly, the study revealed that pump therapy is considerably more costly as compared to MDI treatment. “Total per-person 28-week costs were $8,272 (CGM+CSII) versus $5,623 (CGM+MDI); the difference in costs was primarily attributable to pump use ($2,644),” the authors summarized. It makes sense that cost is one variable that would be a deterrent to someone trying pump therapy, even if they were curious. Several thousands of dollars a year add up and is a considerable expense for so many.

Pump Therapy Decreased the Quality of Life

It may be a surprising finding, but this study actually revealed that pump users “had a significant reduction in quality of life from baseline…compared with controls.” This was determined by assessing the “quality-adjusted life-years (QALYs) via a modified Sheffield T1D model.” Theoretically, there may be many potential reasons why someone may experience a reduced quality of life on an insulin pump, such as worrying about pump site problems, associated financial concerns, the considerations of wearing an additional device, etc.

Pump Therapy Increased A1c Levels and Hypoglycemia

The study authors reported that although pump users spent more time in the 70-180 mg/dL blood glucose range than MDI patients, they “had a higher HbA1c…and more nonsevere hypoglycemic events.” So, in this study, pump therapy did not result in improved control.

Conclusions

A new randomized study compared insulin pump therapy vs. an MDI approach among current CGM users. The results showed that insulin pump users had a higher A1c, decreased quality of life, and markedly higher medical expenses as compared to MDI patients. Of course, these results will need to be validated in a larger cohort, and may also differ between specific populations (e.g., pediatric vs. adult).

“Based on this single trial, initiating an insulin pump in adults with T1D already using CGM was associated with higher costs and reduced quality of life. Additional evidence regarding the clinical effects of adopting combinations of new technologies from trials and real-world populations is needed to confirm these findings,” the researchers concluded.

This trial investigating the clinical and psychosocial effects of pump vs. MDI insulin therapy for type 1 diabetes occurred in a very specific group of patients: those who already use a CGM. It follows that the lack of blood glucose control improvement in the pump group may be due to CGM technology already offering advantages to these parameters; it is possible that many patients who use a CGM have already improved their control and may not see further improvement when adding an insulin pump. Also, CGM users may represent a highly-motivated subpopulation, whereas someone who employs traditional blood glucose monitoring methods may be more likely to benefit from pump therapy. The findings concerning a decreased quality of life on an insulin pump are undoubtedly interesting and warrant further investigation.

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Have you tried both MDI and pump therapy? Perhaps you have switched from one to the other and back again, or stuck with a particular method? We’d love to hear all about your experiences!

Read more about A1c, exercise, insulin, insulin pumps, Intensive management, low blood sugar (hypoglycemia).