Insulin pumps in type 1 diabetes

Pratik Choudhary, MBBS, MD, is a professor and honorary consultant in diabetes in the Diabetes Research Centre at the University of Leicester, UK.

How useful in the treatment of type 1 diabetes is the use of insulin pumps and which patients need such treatment most?

Pratik Choudhary, MBBS, MD: Insulin pumps have been around for ~40 years and we’ve known that by using insulin pumps, we get ~1% reduction in glycated hemoglobin (HbA_1c) if it starts at a high level. For those people starting maybe lower, you can get a 4-fold reduction in hypoglycemia. There are obviously advantages of pumps in managing exercise, managing hypoglycemia, and getting those close to targets. The real advantage of pumps, of course, is when you combine them with closed loops.

But if you’re choosing which patients to prioritize for insulin pump therapy, for me, the evidence suggests that the biggest benefit is in those people who have problematic hypoglycemia. Then, secondly, those people who are running really high—well, people who have to do lots of boluses, lots of quick-acting insulin, because they’re snacking. It’s hard to do that with multiple injections, so a pump makes that a lot easier.