Insulin pumps may be better than shots: report

A type 1 diabetic patient fills her syringe with insulin at the J.W.C.H. safety-net clinic in the center of skid row in downtown Los Angeles, July 30, 2007.

NEW YORK (Reuters Health) - Pumps that deliver insulin to the body as needed may be more effective than insulin injections for helping people with type 1 diabetes keep their blood sugar under control, according to a new review of 23 studies comparing the two approaches.

But the analysis didn't provide evidence on the risk of complications and the costs associated with the two approaches to managing type 1 diabetes.

In people with type 1 diabetes, known as juvenile diabetes even though it can strike people at any age, a person's body loses the ability to secrete insulin. In order to survive and stay healthy, these individuals must monitor their blood sugar closely and give themselves injections of insulin as needed.

A person may also use an insulin pump, which is worn outside the body and delivers insulin under a person's skin in the abdominal area.

Some experts think that the insulin pump might be a better approach, because it eliminates the need for a person to give themselves several injections of insulin a day, and also may "more closely mimic" a normally functioning, insulin-secreting pancreas, Dr. Marie L. Misso of the Australasian Cochrane Center at Monash University in Clayton, Australia and her colleagues note.

To compare the two treatments, Misso and her team identified 23 studies in which a total of 976 people with type 1 diabetes were randomly assigned to insulin injections or insulin pumps.

Insulin pump users, the researchers found, had significantly lower hemoglobin A1c levels, on average, than individuals who injected their insulin, indicating better long-term blood sugar control.

There appeared to be no difference in the risk of having a non-severe episode of low blood sugar, or "hypoglycemia," which occurs when a person takes in too much insulin. But the people using insulin pumps were at lower risk of severe hypoglycemia episodes.

The findings appear in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

In a statement accompanying the report, Dr. Ramin Alemzadeh, director of the Diabetes Program at the Children's Hospital of Wisconsin in Milwaukee, said that effective blood sugar control has more to do with how well a patient and their family are able to manage the condition, rather than what type of approach that patient uses for insulin delivery.

"A patient's diabetes management starts with them and their family. How well they do is independent of which method of insulin administration they use," he elaborated.

SOURCE: The Cochrane Library, 2010.