Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.
Type 2 diabetes usually has a less aggressive treatment approach than those typical with type 1 diabetes—but what if insulin pumps became the standard for type 2s? Medtronic recently reported results from their OpT2mise trial in The Lancet, which showed that people with type 2 diabetes had improved glucose control when using MiniMed insulin pumps instead of their usual multiple day injection regime.
I was curious about this study, since it’s the largest to compare the two therapeutic approaches in people with type 2 diabetes with poor disease control. Results according to Pharma Biz weren’t too surprising. They found that people utilizing insulin pumps “achieved a mean A1c (average blood glucose) reduction of 1.1 percent compared to only a 0.4 percent reduction by those using multiple daily injections.”
But here’s the million-dollar question—is an insulin pump and all of its accouterments worth a 0.7 additional decrease in one’s A1c?
Don’t get me wrong, small improvements are worthy and commendable, but the expense and human interventions necessary for maintenance are much greater than injections. Even in the subset of those living with type 1 diabetes, there still remains a large number of injectors regardless of the proven benefits of pumping.
Reducing blood sugars
Everything has a time and place. Insulin pumps “across the board” surely doesn’t make a great amount of sense, but in certain sub-populations it does. The interesting thing about this study is that improved A1c results were achieved without significant low blood sugar issues, while also decreasing total daily insulin by 20 percent—both of which are notable.
With approximately 1.7 million new diagnoses of type 2 diabetes every year and 51 percent of people aged 65 and older diagnosed with pre-diabetes according to the American Diabetes Association, the concern is real. The triad of obesity, heart disease, and diabetes is taking over the United States like a set of dominoes, which means proper treatment is key.
A1c and type 2 diabetes
Let’s take a look at what Joslin Diabetes Center has to say. Blood sugar management obviously has straightforward guidelines to prevent complications from the disease. Joslin recommends that people with type 2 diabetes keep their A1cs below 7.0, which is an average glucose of 154.
Looping back to the study, A1c improvements in pumps versus shots into this "target zone" were impressive. According to Pharma Biz: “The percentage of participants in the insulin pump therapy group achieving an A1c (below) 8 percent was twice that of the multiple daily injections group (55 percent versus 28 percent).”
That being said, drawing a line in the sand isn’t usually preferable for managing type 2 diabetes because it’s a fluid disease, demanding flexibility with changing treatment profiles.
Keeping a diary of your therapies and test results can create an empowering journal of knowledge guiding both you and your healthcare provider to the proper treatments for your disease process. It all boils down to a matter of choice; ask your care providers for their opinion and come to a decision together on what will work best for you as an individual.