Contents

Search

insulin pump

Indications: Benefits: 1) provides basal & meal bolus insulin requirements 2) provides tighter glucose control in selected patients with type 1 diabetes mellitus 3) reduces variability in absorption from injection sites 4) may benefit patients of all ages (including those < 4 years of age) [3] 5) minimizes nocturnal hypoglycemia [5] 6) 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: 1) hypoglycemia-induced loss of consciousness 2) cardiovascular disease or cerebrovascular disease 3) seizures Complications: 1) catheter site infection 2) interruption of insulin delivery with pump malfunction - ketoacidosis Mechanism of action: - subcutaneously implanted insulin pumps provide continuous delivery of insulin (contrast with artificial pancreas) Clinical trials: 1) Clinical trial comparing insulin pump vs optimized injections [2] a) average glucose control better with pump (18 mg/dL) b) average HgbA1c less with pump (0.5%) c) average total insulin use less with pump (8 units/day) 2) sensor-augmented insulin pump that automatically suspends insulin delivery at a prespecified glucose threshold can reduce the incidence of hypoglycemia [6] 3) closed-loop insulin delivery system [13] 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 Notes: - lack of transparency from manufacturers regarding insulin pump safety [7] - training for patients recommended [7] - patients should report adverse events [7] - insulin pumps over-deliver > 1/2 unit on takeoff & under-deliver a somewhat less on landing [14]

Related

diabetes mellitus type 1 (insulin-dependent, juvenile)

Specific

automated closed-loop insulin delivery; automated insulin dosing controller; automated glycemic controller device; artificial pancreas

General

insulin device (device for administering insulin) infusion pump

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17 American College of Physicians, Philadelphia 1998, 2006, 2015.
  2. 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: 11909787
  3. 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: 12378187
  4. Prescriber's Letter 17(12): 2010 Insulin Pump Therapy Detail-Document#: 261203 (subscription needed) http://www.prescribersletter.com
  5. Bergenstal RM et al Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia. N Engl J Med. June 24, 2013 PMID: 23789889 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1303576
  6. 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 PMID: 24065010 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: 24065008 ama.jamanetwork.com/article.aspx?articleid=1741800
  7. 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 PMID: 25776138 http://care.diabetesjournals.org/content/early/2015/03/13/dc15-0168.full.pdf+html
  8. 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 PMID: 26100640 http://www.bmj.com/content/350/bmj.h3234
  9. 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: 20587585
  10. American Diabetes Association. (6) Glycemic targets. Diabetes Care. 2015 Jan;38 Suppl:S33-40. PMID: 25537705
  11. 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
  12. 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. 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: 31618560 https://www.nejm.org/doi/10.1056/NEJMoa1907863
  14. Tucker ME Air Travel Alters Insulin Pump Delivery on Takeoff, Landing. Medscape.September 27, 2024 https://www.medscape.com/viewarticle/air-travel-alters-insulin-pump-delivery-takeoff-landing-2024a1000hna