A randomized study comparing blood glucose control and risk of severe hypoglycemia achieved by non-programmable versus programmable external insulin pumps

• Published in: Diabetes & metabolism Vol. 27; no. 3; pp. 323 - 327
• Main Authors: CATARGI, B, BREILH, D, GIN, H, RIGALLEAU, V, SAUX, M. C, ROGER, P, TABARIN, A
• Format: Journal Article
• Language: English
• Published: Paris Masson 01-06-2001
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Equipment Design; Female; General and cellular metabolism. Vitamins; Humans; Hypoglycemia - prevention & control; Infusion Pumps, Implantable; Insulin Infusion Systems; Male; Medical sciences; Pharmacology. Drug treatments; Risk Factors; Human; Delivery system; Pancreatic hormone; Hypoglycemia; Insulin; Pump; Chemotherapy; Hypoglycemic agent; Treatment; Risk factor; External; Complication; Portable equipment; Comparative study; Glycemia
• ISSN: 1262-3636; 1878-1780

To compare a non-programmable and a programmable insulin external pump using regular insulin on glycemic stability, the risk of severe hypoglycemia and metabolic control in type 1 diabetic patients.
Ten type 1 diabetic patients were involved in a randomized, crossover study comparing two periods of 3 months with continuous subcutaneous insulin infusion (CSII) either with a non-programmable insulin pump or a programmable insulin pump. Comparisons were made among mean blood glucose values before and after meals, at bedtime and at 2: 00 a.m.; the risk of severe hypoglycemia assessed by the low blood glucose index (LBGI); and HbA1c.
Mean average blood glucose (BG) measurements were significantly lower with the programmable in comparison with the non-programmable insulin pump (respectively 157+/-78 vs. 165+/-79, p=0.034). While postprandial values for BG were not different between the two pumps, the use of the programmable pump resulted in a significant decrease in mean preprandial BG levels (140+/-68 vs. 150+/-73 mg/dl p=0.039). Conversely mean BG level was lower at 2 a.m. with the non-prgrammable pump (125+/-81 vs. 134 +/-93 mg/dl, p=0.02) but with a higher incidence of hypoglycemia. Mean LBGI was comparable with the two pumps (3.1+/-8.6 vs. 2.8+/-6.9, p=0.1). There was a 0.2% decrease in HbA1c during the programmable pump period that did not reach statistical significance (p=0.37).
The present study suggests that programmable external insulin pumps, although more complex and more expensive than non-programmable insulin pumps, significantly reduce fasting glycemia during the day without increasing the risk of severe hypoglycemia and are safer during the night.