No Real HbA1C Difference Between Pump and MDI Therapies Among Newly Diagnosed Children with Type 1 Diabetes

-Craig Idlebrook

As some diabetes advocates pushed the FDA to approve new diabetes tech options, they argued that smart pumps and continuous glucose monitors (CGMs) would lead to better blood sugar management for people with type 1 diabetes. A new study, however, provides evidence that technology in itself doesn’t always create better outcomes.

A study of 294 children who were newly diagnosed with type 1 diabetes found little difference after a year in HbA1c levels between children who used insulin pumps and those who exclusively used multiple daily injection (MDI) therapy. The study was published in The BMJ (British Medical Journal).

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For the study, National Health Service (NHS) researchers recruited children who were newly diagnosed with type 1 diabetes at 15 pediatric diabetes centers across the United Kingdom from May 2011 to January 2017. They divided the children into two groups and initiated either insulin pump therapy or MDI insulin therapy. Both groups were tracked for a year by researchers.

What the researchers found was that those who were utilizing insulin pumps had an average HbA1c of 7.7 (60.9 mmol/mol), while those on MDI had an average HbA1c of 7.5 (58.5 mmol/mol). In other words, there was no real statistical difference between the two groups.

There also was little difference between rates of diabetic ketoacidosis (DKA) and severe hypoglycemia in the two groups. However, parents of children on pump therapy did report a higher quality of life score on average than parents of children on MDI therapy.

It should be noted that the researchers did not measure time in range (TIR) among the participants.  

Different studies imply differing outcomes

This study may provide different results than other studies which have shown better outcomes for those on insulin pump therapy because the researchers focused on the newly diagnosed. Researcher John Cardiff, a professor in pediatric endocrinology at Cardiff University, said in an interview with Medicine Matters that the study was designed in such a way to decrease the chances that it would be filled with participants who were considered highly motivated and might more readily adapt to pump therapy.

Researchers also excluded those children who had siblings with type 1 diabetes. The goal was to make sure that all families in the trial were new to life with type 1 diabetes and would have the same learning curve.

Cardiff was careful in his comments not to downplay the overall promise of insulin pump therapy. However, he suggested that pump therapy’s potential might depend on how motivated an individual or family might be to utilize diabetes technology at the point of initial diagnosis.

There are other factors that may influence how successful insulin pump therapy might be in blood sugar management. Economic status may be one factor – a 2016 University of Toronto study found that children from low-income families on insulin pump therapy were at heightened risk of DKA and other complications than their peers on pump therapy. Another factor may be the quality of training a patient receives in diabetes technology – German researchers found in a 2018 study that a structured insulin pump training program led to better HbA1c for those beginning pump therapy.  

The findings of the NHS study join several other studies which have found that technology alone won’t always lead to better blood sugar management, and that clinical support may be an important factor in the rates of success with diabetes technology.

For example, a 2018 study of 22,470 participants in the T1D Exchange Network Registry found that a fivefold increase in CGM use did not correspond with improved HbA1c among people with type 1 diabetes. More recently, a Boston Children’s Hospital study found that 38 percent of children who began using the Medtronic 670G closed-loop insulin pump stopped using the device over a 15-month period.        

 

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