insulin pump
Jump to navigation
Jump to search
Indications
Benefits:
- provides basal & meal bolus insulin requirements
- provides tighter glucose control in selected patients with type 1 diabetes mellitus
- reduces variability in absorption from injection sites
- may benefit patients of all ages (including those < 4 years of age)[3]
- minimizes nocturnal hypoglycemia[5]
- reduces fatal cardiovascular events (RR=0.58) & all-cause mortality (RR=0.73) relative to daily insulin injections in patients with type 1 diabetes mellitus[8]
Insulin: regular insulin or lisproinsulin
Contraindications
- hypoglycemia-induced loss of consciousness
- cardiovascular disease or cerebrovascular disease
- seizures
Mechanism of action
- subcutaneously implanted insulin pumps provide continuous delivery of insulin (contrast with artificial pancreas)
Complications
- catheter site infection
- interruption of insulin delivery with pump malfunction
Management
- decrease insulin dosage if episodes of hypoglycemia, even if glycemic control is poor*[1]
* brittle diabetics may have episodes of hypoglycemia & hyperglycemia; hypoglycemic unawareness is especially problematic
Clinical trials
- Clinical trial comparing insulin pump vs optimized injections[2]
- average glucose control better with pump (18 mg/dL)
- average HgbA1c less with pump (0.5%)
- average total insulin use less with pump (8 units/day)
- sensor-augmented insulin pump that automatically suspends insulin delivery at a prespecified glucose threshold can reduce the incidence of hypoglycemia[6]
- closed-loop insulin delivery system[13]
Notes
- lack of transparency from manufacturers regarding insulin pump safety[7]
- training for patients recommended[7]
- patients should report adverse events[7]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17 American College of Physicians, Philadelphia 1998, 2006, 2015.
- ↑ 2.0 2.1 Journal Watch 22(10):81, 2002 Pickup J et al Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ 324:705, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11909787
- ↑ 3.0 3.1 Journal Watch 22(23):175, 2002 Litton J et al Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus. J Pediatri 141:490, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12378187
- ↑ Prescriber's Letter 17(12): 2010 Insulin Pump Therapy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261203&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 Bergenstal RM et al Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia. N Engl J Med. June 24, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23789889 <Internet> http://www.nejm.org/doi/pdf/10.1056/NEJMoa1303576
- ↑ 6.0 6.1 Ly TT, Nicholas JA, Retterath A et al Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes. A Randomized Clinical Trial. JAMA. 2013;310(12):1240-1247 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24065010 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1741822
Choudhary P Insulin Pump Therapy With Automated Insulin Suspension. Toward Freedom From Nocturnal Hypoglycemia. JAMA. 2013;310(12):1235-1236 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24065008 ama.jamanetwork.com/article.aspx?articleid=1741800 - ↑ 7.0 7.1 7.2 7.3 Heinemann L et al Insulin Pump Risks and Benefits:A Clinical Appraisal of Pump Safety Standards, Adverse Event Reporting, and Research Needs. A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. March 16, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25776138 <Internet> http://care.diabetesjournals.org/content/early/2015/03/13/dc15-0168.full.pdf+html
- ↑ 8.0 8.1 Steineck I et al Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study. BMJ 2015;350:h3234 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26100640 <Internet> http://www.bmj.com/content/350/bmj.h3234
- ↑ Bergenstal RM, Tamborlane WV, Ahmann A et al Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010 Jul 22;363(4):311-20. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20587585
- ↑ American Diabetes Association. (6) Glycemic targets. Diabetes Care. 2015 Jan;38 Suppl:S33-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25537705
- ↑ FDA News Release. Feb 14, 2019 FDA authorizes first interoperable insulin pump intended to allow patients to customize treatment through their individual diabetes management devices. https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-interoperable-insulin-pump-intended-allow-patients-customize-treatment-through
- ↑ FDA News Release. Jine 27, 2019 FDA warns patients and health care providers about potential cybersecurity concerns with certain Medtronic insulin pumps. https://www.fda.gov/news-events/press-announcements/fda-warns-patients-and-health-care-providers-about-potential-cybersecurity-concerns-certain
Certain Medtronic MiniMed Insulin Pumps Have Potential Cybersecurity Risks: FDA Safety Communication June 27, 2019 https://www.fda.gov/medical-devices/safety-communications/certain-medtronic-minimed-insulin-pumps-have-potential-cybersecurity-risks-fda-safety-communication - ↑ 13.0 13.1 Brown SA, Kovatchev BP, Raghinaru D et al. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. N Engl J Med 2019 Oct 31; 381:1707-1717 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31618560 https://www.nejm.org/doi/10.1056/NEJMoa1907863