Comparative Effectiveness

Insulin pump and glucose monitoring improve blood-sugar control for patients with type 1 diabetes

Sensor-augmented insulin pumps (intensive insulin therapy combined with real-time continuous blood-glucose monitoring) are superior to multiple daily insulin injections and self-monitoring of blood glucose (fingersticks) to lower hemoglobin A1c (the preferred method of assessing blood-sugar control) in patients with type 1 diabetes. That's the conclusion of a research review from the Agency for Healthcare Research and Quality (AHRQ).

The review found an improved quality of life for patients using insulin-intensive therapies and real-time self-monitoring of glucose (sensors attached to the body that continuously measure blood sugar), when the patients wear the sensor at least 60 percent of the time. However, insulin-intensive therapies are expensive and require increased monitoring and engagement with health care professionals, and are not right for every patient. Insulin therapies can be individualized for every patient to accommodate their needs.
Diabetes is a chronic condition that affects nearly 8 percent of Americans. Of the people who have diabetes 90 to 95 percent of them have type 2 diabetes, which is typically characterized as resistance to insulin. Insulin is necessary in order to break down glucose (blood sugar) into energy. Insulin resistance or lack of insulin (type 1 diabetes), or both, can cause severe long-term side effects such as coronary artery disease, chronic kidney disease or retinal damage if untreated. Diabetes can be treated by monitoring glucose levels in the blood and reducing hemoglobin A1c levels, which is done by insulin therapies or through dietary maintenance.
Methods of Insulin Delivery and Glucose Monitoring: A Comparative Effectiveness Review, produced by AHRQ's Effective Health Care Program, summarizes evidence on the effectiveness of intensive insulin therapies in individuals with type 1, type 2 and gestational diabetes. The review suggests additional research is needed to investigate the effectiveness of these treatments in isolation and in specific patient populations.

To access this review and other materials that explore the effectiveness and risks of treatment options for various conditions visit AHRQ's Effective Health Care Program Web site at http://www.effectivehealthcare.ahrq.gov.

Executive Summary – Jul. 10, 2012

Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness

Formats

View PDF (PDF) 723 kB
Help with Viewers, Players, and Plug-ins

Background

Diabetes mellitus is defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion from the pancreatic beta cells; resistance to insulin action at the level of skeletal muscle, liver, and fat; or both. The resultant hyperglycemia, if untreated, can lead to long-term vascular complications.¹ Thirty million people in the United States are diagnosed with diabetes, and that number is expected to increase to 39 million people by 2050.^2-4 Thus, millions of people require glucose-lowering therapies to maintain normal glucose levels (normoglycemia) and prevent diabetes complications.
Type 1 diabetes, which accounts for 5 to 10 percent of all diabetes cases, is characterized by insulin deficiency and a need for daily insulin administration to sustain life, maintain normoglycemia, and maintain normal body weight and promote normal growth and development in children.¹ Type 2 diabetes, which accounts for 90 to 95 percent of diabetes in the United States, is the result of a combination of insulin resistance and impaired insulin secretion by the beta cells of the endocrine pancreas.1 Eventually, beta cell failure can lead to insulin deficiency, necessitating insulin therapy. In pregnant women with pre-existing type 1 or type 2 diabetes, poor glycemic control is associated with poorer pregnancy outcomes.

full-text:
http://www.ahrq.gov/research/oct12/1012RA27.htm