According to new Johns Hopkins research published online in the July 10 issue of the Annals of Internal Medicine, newer technologies designed to assist diabetes type 1 patients monitor blood sugar levels daily are superior to traditional methods and require less, painful pricks of a needle.
The findings indicate that despite the higher cost of these diabetic control technologies, diabetic patients using an insulin pump are more satisfied with their therapy and quality of life compared with those who need to administer themselves with several insulin injections each day. The researchers decided to investigate the long-term effect of this new convenient technology compared with the traditional method.
Senior study author, Sherita Hill Golden, M.D., M.H.S., an associate professor in the division of endocrinology and metabolism at the Johns Hopkins University School of Medicine explained:
"Our study was designed to help patients and physicians better understand the effectiveness of insulin pumps and blood sugar sensors that provide constant glucose monitoring compared to conventional approaches. We found that certain devices confer real benefits."
A body of a type 1 diabetic is unable to adequately manage the blood's glucose (sugar) levels, by failing to produce insulin, which regulates the body's use of glucose, meaning that the person needs to frequently monitor their insulin levels, injecting themselves with insulin to keep blood sugar levels even at all times and particularly before and after meals. The monitoring usually involves frequently pricking a finger every day to obtain blood, which is then put on a test strip so that the glucose monitor can calculate the levels of blood sugar. Without strict monitoring, diabetics can sustain serious and chronic complications, like blindness and tissue damage. About 5 to 10% of diabetics suffer from type 1 diabetes, known as juvenile-onset diabetes.
Golden and her team conducted a meta-analysis, reviewing and re-assessing data from 33 randomized controlled trials, which compared new technologies, consisting primarily of real-time continuous glucose monitoring devices and insulin pumps to standard monitoring and blood sugar level controlling methods.
Continuous monitoring devices track blood sugar levels 24/7 as often as every five minutes by using a sensor held in place by tape attached to the abdomen with a small needle. The sensor then transmits the results to a display worn on a belt, sounding an alarm if the blood sugar level is dangerously high or low. Based on the results, diabetics can then decide whether they need to adjust their insulin intake and/or activity levels. However, patients still need to obtain blood from their fingers about two to four-times daily to ensure proper functioning of the device, although this is less than having to obtain blood for as many as 8 to 10 times a day for those who try to strictly control their blood sugar levels.
Results of the study showed that children, teens and adults with type 1 diabetes using continuous monitoring had lower blood glucose levels than those who used the conventional finger stick test alone and that the duration of having too much blood sugar (hyperglycemia) was overall also less as compared with those using the conventional method, although both methods were found to work equally well in controlling hypoglycemia.
Insulin pumps are small devices providing insulin around the clock through a small tube and needle that goes under the skin into the belly area, which is attached to the insulin pump. Diabetics can either program the device with the push of a button if they measured their glucose levels using the finger stick method or link the pump to the continuous monitor, called a "sensor-augmented pump".
Although the findings showed little variations in blood sugar control in those who administered themselves multiple insulin shots per day compared with those using insulin pumps, type 1 diabetics using the sensor-augmented pumps, i.e. pumps that include real-time continuous glucose monitoring devices, fared significantly better in controlling their blood sugar compared with those using the finger stick testing and shots.
Given the higher price of the new devices, Golden argues that it is vital to ensure that these devices are used by those patients, who can reap the most benefit, saying: "Those who use the devices as prescribed do the best at maintaining blood sugar control. Adherence is the key to effectiveness."
According to Golden, not all insurance companies cover the new technologies. For instance, Medicare does not cover the real-time continuous glucose monitoring sensors. She concludes stating that the study was unable to determine whether or not particularly those over 65 would benefit from using the device.
Written by Petra Rattue