BMJ: Insulin pump or reduce cardiovascular risk in patients with type 1 diabetes
Release date: 2015-07-06
Although the number of patients with type 1 diabetes (T1DM) is small compared with patients with type 2 diabetes (T2DM), the risk of cardiovascular disease is high in patients with type 1 diabetes. Compared with T2DM, the T1DM line of intensive glycemic control (using insulin) to reduce the complications of large blood vessels and microvessels has been clearly demonstrated. This intensive glycemic control is usually performed by multiple injections per day (MDI). Insulin pumps, often equipped with blood glucose monitoring, provide a simpler and more continuous route of insulin administration, and are used more in younger patients. Although theoretically there are many benefits to insulin use, prospective studies have shown that there is no difference in the effect of insulin pumps on cardiovascular disease compared to MDI.
Figure 1. 18168 patients with type 1 diabetes treated with insulin pump or MDI
Kaplan-Meier survival curve
In this observational study, Steineck and colleagues found that the use of insulin pumps in T1DM patients at the Swedish National Diabetes Registry was associated with fewer fatal and non-fatal cardiovascular complications after nearly seven years of follow-up. Interestingly, the insulin pump did not observe a significant difference in HbA1c levels compared to MDI (mean HbA1c - 8%), but patients with insulin pumps seldom developed hypoglycemia. However, although a large amount of data from this study has corrected for confounding factors, we still cannot distinguish from these data whether there is a causal relationship between the two (for example, insulin pump use is better) or simply because of healthy patients. The insulin pump is compared to the patient using MDI. There are several theories that explain the principle of insulin pumps to improve blood sugar, including reducing the incidence of hypoglycemia and reducing the incidence of postprandial hyperglycemia.
Figure 2 occurred in patients with type 1 diabetes at 7 years of follow-up
Kaplan-Meier survival curve of hypoglycemic events
Compared to MDI, insulin pumps offer more flexible and simple insulin delivery measures and may better protect the cardiovascular, but further prospective studies are needed to confirm the validity of this hypothesis.
Expand knowledge:
Insulin Pump:
The insulin pump consists of a pump, a small syringe and an infusion tube connected to it. The small syringe can hold up to 3 ml of insulin. After the syringe is loaded into the pump, the guiding needle at the front end of the connected infusion tube is inserted into the patient's skin with a needle injector (conventional abdominal wall), and then the screw motor of the insulin pump is driven by the battery. Pushing the piston of a small syringe and infusing insulin into the body The basic purpose of the insulin pump is to simulate the secretion function of the pancreas. The insulin is continuously injected into the skin of the user according to the dose required by the human body, and the blood glucose is kept stable throughout the day to achieve control. The purpose of diabetes.
How does the insulin pump work?
Original source:
Insulin Delivery Method and Cardiovascular Mortality in Type 1 Diabetes.
Steineck I1, Cederholm J2, Eliasson B3, Rawshani A4, Eeg-Olofsson K3, Svensson AM4, Zethelius B5, Avdic T4, Landin-Olsson M6, Jendle J7, Gudbj? Rnsdóttir S8; Swedish National Diabetes Register. Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18?168 people with type 1 diabetes: observational study.BMJ. 2015 Jun 22;350:h3234. doi: 10.1136/bmj.h3234. [pdf free]
Source: Medsci
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