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AI-Generated response:

Who is the best group for the use of the insulin pump?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

The best group for the use of the insulin pump includes patients with type 1 diabetes who are motivated to achieve optimal glucose control, capable of managing the complex therapy, and willing to maintain frequent contact with their healthcare team.

Safety considerations include ensuring patients are trained on carbohydrate counting, frequent glucose monitoring, and maintenance of infusion sets to prevent issues such as severe hypoglycemia or diabetic ketoacidosis.[1-3]

  • Insulin pump therapy is particularly beneficial for patients with type 1 diabetes who perform multiple daily insulin injections and self-monitor blood glucose levels at least three times a day.[1-2]

  • Patients who are motivated and able to engage in the tasks required for managing insulin pump therapy, such as carbohydrate counting and adjusting basal insulin rates, are ideal candidates.[1-2]

  • Insulin pumps can provide better glycemic control and reduce the frequency of severe hypoglycemia compared to multiple daily injections, especially when combined with continuous glucose monitoring systems.[2-4]

  • Automated insulin delivery systems, which include insulin pumps, are recommended for all capable patients with type 1 diabetes, as they can significantly improve time in the target glucose range and reduce hypoglycemic events.[1-2]

  • Children, adolescents, and young adults with type 1 diabetes also show improved clinical outcomes with insulin pump therapy compared to injection therapy.[3][5]

Additional info

Insulin pump therapy, particularly when integrated with continuous glucose monitoring systems, represents a significant advancement in diabetes management, offering more precise control over blood glucose levels and reducing the risk of complications associated with diabetes, such as severe hypoglycemia and diabetic ketoacidosis. The American Diabetes Association and other professional societies recommend these systems for patients who are able and willing to manage the complexities of the therapy. Continuous education and support from healthcare providers are crucial to ensure the safe and effective use of these devices. The development of fully automated systems in the near future is anticipated to further enhance the management of type 1 diabetes, potentially making these devices suitable for a broader range of patients.

References

Reference 1

1.

Elsevier ClinicalKey Clinical Overview

Treatment One advantage of insulin pump therapy is the ability to vary rates of basal insulin administration. Basal rates can be adjusted to match lower insulin needs (for example, the basal rate can be decreased for vigorous exercise) A meta-analysis of 25 randomized controlled trials, examining the effects of CSII on glycosylated hemoglobin, hypoglycemic events, and time spent in hypoglycemia, found a modest reduction in hemoglobin A1C in patients with T1D (all BMI ranges) who used CSII, compared with those who used MDI (mean difference, 0.37%; 95% CI, 0.24-0.51) Automated insulin delivery systems consist of an insulin pump, a continuous glucose monitor, and a software algorithm that controls insulin delivery. Currently available hybrid systems can determine insulin delivery in the basal state but still require bolus mealtime insulin injections based on carbohydrate counting Initial data on these hybrid systems (from persons with T1D and healthy body weight and persons with T1D and obesity) suggest that these systems may improve glycemic control, improve time in range, and reduce hypoglycemic episodes It is anticipated that within the next few years, fully automated insulin delivery systems will become available

Reference 2

2.

Elsevier ClinicalKey Clinical Overview

Treatment In hybrid closed-loop systems, pump automatically adjusts delivery of basal insulin based on glucose values as determined by the continuous glucose monitor, without requiring intervention from the user; the pump automatically increases, decreases, and suspends basal insulin delivery in response to continuous glucose monitoring; user initiates delivery of mealtime boluses More advanced systems also deliver automated correction boluses (advanced hybid closed-loop systems) Patients using completely automated insulin delivery systems had greater reduction in hemoglobin A1C and spent a greater percentage of time in the target glucose range without an increase in frequency of hypoglycemia compared with those using other modes of insulin delivery along with continuous glucose monitoring Several commercially available hybrid closed-loop systems have been approved by FDA Patients may also develop "do-it-yourself" closed-loop systems using open-source algorithms designed to automate insulin delivery that link to existing continuous glucose monitors and insulin pumps; these have glycemic efficacy similar to that of commercially available systems Guidelines for implementing commercial and open-source automatic insulin delivery systems in diabetes management have been developed American Diabetes Association has developed a resource to help clinicians and patients in choosing the initial device to be used Subsubsection Title: Indication: Any motivated patient who is intensively managed and has received comprehensive diabetes education Ideal candidates are those who currently perform at least 3 insulin injections and self-monitored blood glucose measurements daily and who are: Motivated to achieve optimal blood glucose control Willing and able to carry out the tasks required to use this complex and time-consuming therapy safely and effectively (eg, carbohydrate counting, frequent blood glucose monitoring, maintenance of infusion sets) Willing to maintain frequent contact with the health care team American Diabetes Association recommends offering insulin pump therapy or automatic insulin delivery systems to all patients with type 1 diabetes who are capable of using the devices safely, either by themselves or with caregiver assistance

Treatment Subsubsection Title: Procedures: Subsubsection Title: Continuous subcutaneous insulin infusion (insulin pump) therapy: Subsubsection Title: General explanation: Mechanically driven insulin delivery technology in which a catheter is placed subcutaneously to provide a continuous infusion of rapid-acting insulin Provided as a preset basal rate with operator-driven periodic boluses; basal delivery rate can be programmed to vary throughout the day A sensor-augmented pump is a continuous subcutaneous insulin infusion device combined with a continuous glucose monitoring feature A pump with threshold suspension functionality temporarily halts delivery of insulin when interstitial glucose levels fall below a set threshold Use of sensor-augmented pump therapy with threshold suspension functionality reduces rate of severe hypoglycemia Sensor-augmented pumps are superior to multiple daily insulin injections for improving glycemic control without increasing the risk for hypoglycemia Comparison of outcomes using multiple daily insulin injections versus continuous subcutaneous insulin infusion shows that the latter is associated with slightly lower hemoglobin A1C levels DKA improved quality of life Use of continuous subcutaneous insulin infusion is associated with reduction in all-cause and cardiovascular mortality when compared with multiple daily insulin injections Automated insulin delivery systems that combine an insulin pump, a continuous glucose sensor, and an algorithm controller that adjusts insulin delivery are available; these form an artificial or "bionic pancreas" Patients still must enter carbohydrate intake and periodically calibrate the sensor The simplest form is a sensor-augmented pump that suspends insulin delivery when glucose reaches low threshold; these pumps are ideal for patients with frequent nocturnal hypoglycemia, recurrent severe hypoglycemia, or hypoglycemia unawareness

Reference 3

3.

Elsevier ClinicalKey Clinical Overview

Treatment Care givers should be aware that do-it-yourself systems that combine a continuous glucose monitor and an insulin pump with a controller and an algorithm are widely used One such system that uses a phone-based app was recently approved by the FDA Comparison of outcomes using multiple daily insulin injections versus continuous subcutaneous insulin infusion shows that the latter is associated with slightly lower hemoglobin A1C levels, less DKA, improved quality of life Use of continuous subcutaneous insulin infusion is associated with reduction in all-cause and cardiovascular mortality when compared with multiple daily insulin injections Subsubsection Title: Indication: Suggested indications vary among different professional societies American Diabetes Association International Society for Pediatric and Adolescent Diabetes American Association of Clinical Endocrinologists suggests consideration of continuous subcutaneous insulin infusion therapy for children with type 1 diabetes under the following circumstances: Elevated hemoglobin A1C levels on injection therapy Frequent, severe hypoglycemia Widely fluctuating glucose levels Microvascular complications and/or risk factors for macrovascular complications Hybrid closed-loop systems are intended for patients aged 14 years or older with type 1 diabetes Subsubsection Title: Contraindications: Do not use hybrid closed-loop system in the following: Anyone younger than 7 years Patients who require less than a total daily insulin dose of 8 units/day; requires a minimum of 8 units/day to operate safely Subsubsection Title: Interpretation of results: Insulin pumps equipped with predictive threshold-suspend features appear to reduce hypoglycemia 2-fold (compared to standard sensor-augmented pumps without suspension feature) without deterioration in glycemic control Hybrid closed-loop systems have been shown to be safe during in-home use by adolescents (and adults), to provide reductions in hypoglycemia and hyperglycemia, and to result in lower hemoglobin A1C values

Reference 4

4.

Elsevier ClinicalKey Clinical Overview

Treatment In general, using premixed insulin formulations, such as 70/30, which are a combination of intermediate-acting insulin and regular/rapid insulin analogues, increases the risk of hypoglycemia compared with basal insulin alone More frequent glucose monitoring and comprehensive diabetes education, including specific training about the avoidance of hypoglycemia, may reduce the risk of severe episodes Use of CGM devices should reduce the risk of severe hypoglycemia, but the evidence for this is not strong in type 2 diabetes. It may be more effective in those at risk for hypoglycemia Subsubsection Title: For Patients With Type 1 Diabetes: For those on MDIs (multiple daily injections), use of long-acting basal insulin analogues (glargine, detemir, degludec) reduces the risk of symptomatic (especially nocturnal) hypoglycemia over NPH. For those on MDI, use of rapid-acting insulin analogues (lispro, aspart, glulisine) over regular human insulin before meals may also reduce the risk of hypoglycemia Use of continuous subcutaneous insulin infusion devices ("insulin pumps") alone (versus MDI) does not appear to reduce the risk of hypoglycemia, although they may allow the achievement of a lower hemoglobin A1c without increasing hypoglycemia risk More modern insulin pumps communicating with CGM sensors in hybrid-closed loop systems, however, do reduce the risk of severe hypoglycemia over MDI Use of integrated hybrid closed-loop systems involving an insulin pump communicating and partially driven by a CGM device has also shown advantages over open-loop pumps (ie, not integrated with CMG) in reducing the risk of severe hypoglycemia

Reference 5

5.

Karges B, Schwandt A, Heidtmann B, et al. Jama. 2017;318(14):1358-1366. doi:10.1001/jama.2017.13994.

Publish date: October 2, 2017.

These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes.

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