18 Nov Less Than 50% of Type 1 Diabetic Youth Receive Insulin Pump Therapy
MedicalResearch.com Interview with:
Jennifer Lynn Sherr, MD, PhD
Assistant Professor of Pediatrics (Endocrinology)
Yale School of Medicine
Medical Research: What is the background for this study?
Dr. Sherr: A joint consensus statement released in 2007 by leading pediatric diabetologists recommended pump therapy be considered in children and adolescents with suboptimal diabetes control, wide fluctuations in blood glucose levels regardless of HbA1c, and when insulin regimen compromises lifestyle, indications which would encompass the vast majority of youth living with type 1 diabetes. Yet, variations in the support for and use of pump technology has been reported even in developed Western countries. Therefore, the present study was undertaken to assess the frequency of pump use across three large registries of pediatric type 1 diabetes patients: the German/Austrian Prospective Diabetes Follow-up Registry (DPV), the US T1D Exchange (T1DX), and the English/Welsh National Paediatric Diabetes Audit (NPDA).
Medical Research: What are the main findings?
Dr. Sherr: Our data demonstrate that fewer than 50% of youth in these five countries are using pump therapy. Those on pump therapy had mean lower HbA1c levels as compared to those on injection therapy. Notably, a three-fold greater use of insulin pumps was noted in thetype 1 diabetes and DPV as compared to the NPDA, which may be due to the National Institute for Health Care Excellence (NICE) guidelines limiting pump use in these countries.
Pump use amongst the registries varied widely by age. Additionally, the data demonstrate lower pump use in both ethnic minorities and males.
Medical Research: What should clinicians and patients take away from your report?
Dr. Sherr: As data from three trans-Atlantic registries have identified the beneficial glycemic effect of insulin pump use with mean A1c being 0.5% lower than what is achieved by those on injection therapy, application of this technology for all youth with type 1 diabetes should be a focus of care. Clinicians should investigate their prescribing patterns and be aware that pump use can be applied regardless of patient age, gender, or ethnic background. Patients should advocate for themselves in order assure they are being considered for this treatment modality.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Sherr: Assessment of factors related to determining who is eligible for pump therapy and how we can assure equal access regardless of age, ethnic status or gender will be important. Additionally, exploration of health policy allowing for coverage of such medical devices is warranted to assure our youth are afforded the best care possible. This will become critically important, as the next revolution of diabetes care is a mechanical solution, specifically the artificial pancreas, which relies on insulin pump use for system performance.
Sherr JL1, Hermann JM2, Campbell F3, Foster NC4, Hofer SE5, Allgrove J6, Maahs DM7, Kapellen TM8, Holman N9, Tamborlane WV1, Holl RW2, Beck RW10,Warner JT11; T1D Exchange Clinic Network, the DPV Initiative, and the National Paediatric Diabetes Audit and the Royal College of Paediatrics and Child Health registries.
Jennifer Lynn Sherr, MD, PhD (2015). Less Than 50% of Type 1 Diabetic Youth Receive Insulin Pump Therapy