Introduction
The article explores a study conducted by Johnson, Copper, Jones, and Davis (2013) to determine the long-term effect of using insulin pump therapy in the treatment of type 1 diabetes in children. The aim of the study was to determine the impact of insulin therapy pump on the management of type 1 diabetes in children based on factors that included diabetic ketoacidosis (DKA), body mass index (BMI), the prevalence of hypoglycemia, and glycemic control (Johnson et al., 2013).
The study demonstrated that insulin pump therapy aids in the management of diabetes by enhancing glycemic control, lowering instances of severe hypoglycemia, and reducing complications related to diabetic ketoacidosis.
Article summary
The authors start the article by providing a literature review of past studies regarding the topic. The application of insulin pump therapy has largely been based on the ability to control glycemia. Improvements in pump technology and the availability of insulin analogues have played a great role in influencing the efficacy of the technology (Batajoo, Messina, & Wilson, 2012). Despite numerous improvements, these technological advancements have initiated heated debates regarding the effectiveness of pump therapy.
Different studies have reported conflicting findings regarding the efficacy of pump therapy mainly because of differences in study periods and approaches (Maahs, Horton, & Chase, 2010). Few studies have been conducted to determine the effectiveness of insulin pump therapy in children. The Princess Margaret Hospital has presented findings that showed that pump therapy is an effective method in diabetes control because patients who underwent the treatment showed a reduction in HbA1c of 0.5% (5.5 mmol/mol) and a 65% reduction in instances of severe hypoglycemia (Johnson et al., 2013).
In order to determine the effectiveness of the technology, the researchers utilized a case-control design. The experimental group included patients undergoing insulin therapy while the control group included patients undergoing injection therapy. Participants undergoing injection therapy were further divided into two groups depending on the number of injections that were administered daily. The study involved 502 participants.
However, only 345 patients met the criteria of the study. The researchers found out that insulin pump therapy is an effective method for improving glycemic control. The intervention was efficacious because the researchers found out that the improvements experienced from insulin pump therapy lasted at least 7 years. Patients experienced an average improvement in HbA1c of 0.6% (6.6 mmol/mol), thus, validating the findings of related studies (Johnson et al., 2013).
This improvement is significant in clinical practice because the Diabetes Control and Complications Trial (DCCT) has linked a 1% reduction in HbA1c with a corresponding reduction in microvascular complications of between 21 and 49% (Johnson et al., 2013).
The findings of the study were consistent with the results of related studies that proved that insulin pump therapy leads to significant reduction in HbA1c. In order to ensure that the intervention is effective, medical practitioners monitor the glucose levels of patients and educate them and their families about diabetes control. During the study, this education resulted in early improvements in HbA1c. In addition, the pump technology also motivated patients to take control of their health by participating actively in managing their conditions.
Waning enthusiasm for the new technology among patients had significant effects. The researchers realized that initial improvements were experienced in the first 24 months of the study after which they noted increases in HbA1c, which declined further for the next 2 years (Johnson et al., 2013). In contrast, they realized a steady increase in HbA1c among patients undergoing injection therapy. As a result, the outcomes of pump therapy became pronounced as years progressed.
The authors refute claims that insulin pump therapy does not benefit children with poor glycemic control. On the contrary, they argue that these children experience the greatest improvements after undergoing the intervention. This argument was augmented by the findings of the study. Patients who commenced the pump therapy with HbA1c of ≥8.5% (69.4 mmol/mol) experienced the greatest improvements (Johnson et al., 2013).
Insulin pump therapy was also effective in reducing hypoglycemia and improving patients’ quality of life. The findings of the study revealed that the rate of severe hypoglycemia reduced by 30% after patients commenced pump therapy (Johnson et al., 2013). Certain complications of pump therapy can be prevented through frequent monitoring of glucose levels. The researchers found out that the rate of DKA prevalence was 50% lower in the pump therapy group than in the injection therapy group (Johnson et al., 2013). The authors note that motivation and willingness to monitor one’s glucose levels are important for patients preparing for insulin pump therapy.
Conclusion
The findings of the study revealed that insulin pump therapy is an effective intervention in the management of type 1 diabetes in children because it leads to improvements in glycemic control. These improvements last for long periods of time. In patients undergoing pump therapy, there was considerable reduction in severe hypoglycemia and DKA. In addition, the patients did not show any increase in BMI. Contrary to perceptions, the greatest improvements were experienced in children with poor glycemic control.
Reference
Batajoo, R. J., Messina, C. R., & Wilson, T. A. (2012). Long-term Efficacy of Insulin Pump Therapy in Children with Type 1 Diabetes Mellitus. Journal of Clinical Research in Pediatric Endocrinology 4 (3), 127-131.
Johnson, S. R., Cooper, M. N. Jones, T. W., & Davis, E. A. (2013). Long-Term Outcome of Insulin Pump Therapy in Children with Type 1 Diabetes Assessed in a Large Population-Based Case-Control Study. Diabetologia 56, 2392-2400.
Maahs, D. M., Horton, L. A., & Chase, H. P. (2010). The Use of Insulin Pumps in Youth with Type 1 Diabetes. Diabetes Technology & Therapeutics 12(1), 59-65.