Date: 30 March 2017
Insulin pumps are no more effective than injections at helping people with type 1 diabetes control their blood sugar levels, if they are yet to receive full training to self-manage their condition. Ensuring that people have sufficient training could be highly beneficial, reports new research.
The REPOSE trial, funded by the National Institute for Health Research (NIHR) and supported by the NIHR Sheffield CRF, found that using a pump did not help patients whose blood glucose levels were high and who had yet to receive structured education to improve glycaemic control. However, participants using the pumps were more satisfied with their treatment.
The study, led by Professor Simon Heller of Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield, has published in The BMJ today.
Type 1 diabetes is a condition where the pancreas isn’t able to produce insulin and causes high blood sugar levels. It affects around 250,000 people in the UK. Patients with this form of diabetes need to supply insulin using either a pump or injections to keep blood glucose at a normal level.
Insulin is usually injected daily and the dose is changed to fit with food intake and exercise. An infusion pump continuously supplies insulin using a device that sits just under the skin.
The use of pumps is expensive, but can provide patients with a more flexible way of delivering their insulin. However, until now, little research has been done to see how effective the pump is compared with injections.
The team at Sheffield Teaching Hospitals NHS Foundation Trust allocated 267 participants (at 8 centres across England and Scotland) onto a week-long educational course, Dose for Adjustment for Normal Eating (DAFNE) programme, to learn about flexible insulin therapy. They were then split into two groups. One group also received training on how to use a pump to deliver their insulin while the second group used multiple insulin injections for two years.
Professor Heller, an NIHR Senior Investigator said: “Offering pumps to adults whose blood glucose levels are high and who have not yet received training in insulin self-management doesn’t appear to offer additional benefit. What the results do suggest is that ensuring people receive training to enable them to better manage their diabetes is likely to be more beneficial. Pumps may be useful in patients who are highly engaged in their own management, but find that the limitations of insulin treatment prevent them achieving their glucose targets”.
Dr Martin Ashton-Key, Scientific Director at the NIHR Evaluation Trials and Studies Coordinating Centre added: “The findings of this NIHR-funded research will be of real value to patients with diabetes and clinicians in the NHS.”
Andy Broomhead, 35 of Chapeltown, Sheffield, took part in the REPOSE trial and received structured support to manage his diabetes through the Dose for Adjustment for Normal Eating (DAFNE) programme:
“Taking part in a DAFNE course as part of the REPOSE trial changed my life. DAFNE gave me the freedom, flexibility and confidence to manage my own Type 1 diabetes confidently for the first time in a decade. I now feel empowered to look after myself and it's made me feel more confident living with Type 1 diabetes every day.
“Whilst it can be hard to put up with checking my own blood glucose seven or eight times a day, calculating carbohydrate values and then deciding how much insulin I need to give myself for every meal, I know how important it is to get those things right. DAFNE has given me the skills I need to look after my own health and I'd encourage anyone who hasn't yet been on the course to do so.”
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