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Insulin Pump Therapy in Evidence-Based Practice

Introduction

Diabetes on the whole and type 1 diabetes (T1D) in particular is a burden for American health care. Consequently, its management is one of the major concerns in clinical practice. Since T1D can lead to undesirable complications that result from ineffective care, strict blood glucose control is vital for patients with this disease (Sherr et al., 2015). There is evidence from clinical trials that blood glucose control has the potential to reduce the risk of developing microvascular diabetes complications in patients with T1D (Szypowska et al., 2016).

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Still, some patients with T1D, including children, can have problems with timely insulin injections due to the lack of awareness of their importance. For these and other patients, there is an opportunity to support sustainable blood glucose levels, such as insulin pumps. This essay analyses the article by Johnson, Cooper, Jones, and Davis (2013), which presents the results of a large population-based case–control study dedicated to long-term outcomes of insulin pump therapy in children with T1D.

The Main Idea of the Research Findings

The study under consideration is aimed to determine the impact of insulin pump therapy on such indicators as long-term glycaemic control, body mass index (BMI), as well as the level of severe hypoglycemia and diabetic ketoacidosis (DKA) in children. The sample included 345 children with T1D from a single pediatric tertiary hospital, both on pump therapy and treated by injections. The major factors for inclusion in the sample were age, duration of the disease, and HbA1c at the time pump therapy was initiated (Johnson et al., 2013).

The research findings are related to the major aspects considered in the study, such as glycaemic control, hypoglycemia, and complications observed during therapy. Glycaemic control was measured at different states of the study. For both pump and non-pump cohorts, seven years of follow-up were considered for the study at three points of time and annually after the end of the experiment. Data analysis reveals the mean difference of 0.6% between the two groups over the period of follow-up (Johnson et al., 2013).

After the beginning of pump therapy, the experimental cohort demonstrated an increase in HbA1c at every time point. The most significant improvement was registered at 3 months, while the least improvement was observed at two years of pump therapy. Moreover, patients on pump therapy had a more significant improvement of HbA1c compared to patients on all types of injection therapy considered in this experiment, such as multiple daily injections, injections three times and twice daily (Johnson et al., 2013). These facts support the hypothesis that pump therapy has a positive impact on the level of HbA1c in children with T1D and thus can be recommended for use in clinical practice.

As for the rate of severe hypoglycemia, it was higher among the patients of the pump group before the beginning of insulin pump therapy. Nevertheless, after the therapy was initiated, the rate of hypoglycemia in the pump cohort shortened to 50% compared to figures recorded a year prior to the experiment. At the same time, the incidence of severe hypoglycemia in the non-pump cohort grew. On the whole, patients using pump therapy had a 30% lower rate of hypoglycemia compared to those using injection therapy during the follow-up period (Johnson et al., 2013). Therefore, it can be concluded that insulin pump therapy has the potential to reduce the incidence of severe hypoglycemia in patients with T1D.

Complications should also be considered as a factor of the efficiency of the therapy under discussion. For T1D, complications include diabetic ketoacidosis and gaining weight, which results in an increase in BMI. Thus, before the experiment, the rate of hospitalization of patients with diabetes due to diabetic ketoacidosis was the same for both cohorts. After the experiment started, patients from the non-pump cohort were hospitalized more frequently than those applying pump therapy.

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On the whole, during the experiment and the years of follow-up, patients using insulin injections were hospitalized with diabetic ketoacidosis twice more often than patients using insulin pump therapy. Consequently, insulin pump therapy has a positive impact on the rate of complications among patients with T1D and can reduce the number of hospitalizations. As for the BMI, there was no meaningful difference between the representatives of the two cohorts before the experiment. After the application of pump therapy, the need for insulin among the pump cohort decreased by 9%. Therefore, a conclusion can be made that insulin pump therapy leads to a decrease in the insulin dosage, thus preventing weight gain.

Conclusion

To summarizing, it should be mentioned that insulin pump therapy is an opportunity to preserve the quality of life of patients with T1D, releasing them from the necessity to make regular injections. It is particularly important for children who have more active lives and worse habits of self-control. Moreover, clinical trials provide evidence that insulin pump therapy is more effective in many aspects such as glycaemic control, reduction of diabetes-related complications, and the shortening of severe hypoglycemia rates. Therefore, it can be recommended for diverse cohorts of patients, including children.

References

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(11), 2392-2400.

Sherr, J., Hermann, J., Campbell, F., Foster, N., Hofer, S., Allgrove, J., … Warner, J. T. (2015). Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: Comparison of results from three large, transatlantic paediatric registries. Diabetologia, 59(1), 87-91. Web.

Szypowska, A., Schwandt, A., Svensson, J., Shalitin, S., Cardona-Hernandez, R., Forsander, G., … Madacsy, L. (2016). Insulin pump therapy in children with type 1 diabetes: Analysis of data from the SWEET registry. Pediatric Diabetes, 17, 38-45. Web.

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StudyCorgi. 2021. "Insulin Pump Therapy in Evidence-Based Practice." August 11, 2021. https://studycorgi.com/insulin-pump-therapy-in-evidence-based-practice/.

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StudyCorgi. (2021) 'Insulin Pump Therapy in Evidence-Based Practice'. 11 August.

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