Insulin pumps vs injections
ANGLAIS
(Taken from the American Journal of Nursing’s Journal Watch column, resuming recent scientific publications)
According to this study, sensor-augmented insulin pumps (SAP) significantly improved glycated hemoglobin levels compared with daily injections in patients with poorly controlled type 1 diabetes.
Bergenstal et al compared the efficacy and safety of sensor-augmented insulin pumps (SAP) and insulin injections in reducing levels of glycated hemoglobin (HbA1c) in 485 patients with type 1 diabetes. Patients were randomized to receive pump (n = 244) or injection (n = 241) therapy. The groups were also stratified by age (7-18 years and 19-70 years). All patients received diabetes management training, and those in the pump group received online pump training as well as additional training at the sites.
The mean baseline HbA1c level in both groups was 8.3 %. One year after study initiation, the mean HbA1c level in the pump group was 7.5 % compared with 8.1 % in the injection group. In general, individual HbA1c levels were lower in both children and adults in the pump group compared with those in the injection group. Post hoc analysis of a subset of patients showed that HbA1c levels in the pump group fell quickly between baseline and three months and remained below those in the injection group for the remainder of the trial.
After one year, more patients in the pump group than in the injection group reached the HbA1c target level of 7 % or less (27 % versus 10 %, respectively). In addition, a greater percentage of both adults (34 %) and children (13 %) in the pump group achieved the target HbA1c level than adults (12 %) and children (5 %) did in the injection group. Incidence of severe hypoglycemia and diabetic keto–acidosis was comparable between groups.
(Bergenstal RM, et al., N Engl J Med 2010 ; 363(4) : 311-20.)
Published in AJN, march 2011, Volume 111 – Issue 3 – p. 62.
MOTS ET EXPRESSIONS
SAP : insulin pump and continuous glucose sensor in one device
Pompe à insuline avec capteur de glucose intégré
Randomized (adj) Tiré au sort
Post hoc (adv) ultérieur, a posteriori. Dans une analyse, trouver une tendance après une expérience.
Target level (n) Niveau cible
QUESTIONS
1. In which situation SAP and daily injections were compared as to their efficacy ?
In reducing HbA1c levels for patients with poorly controlled type 1 diabetes.
2. Compare the children’s HbA1c levels in both groups after one year.
After one year, 13 % of the pump group children achieved the HbA1c target level of 7 % compared with 5 % of the injection group children.
3. In which group was severe hypoglycemia incidence higher ?
The incidence was comparable between groups.