Insulin Pump Therapy for Type 2

Transcription

1 Insulin Pump Therapy for Type 2

2 Objective To show the effectiveness of CSII for insulin-taking type 2 patients Key Points Tight glycemic control decreases risk of diabetes-related complications in patients with type 2 diabetes, per the UKPDS study CSII can produce greater reductions in A1C compared with multiple daily injections CSII helps reduce daily insulin requirements in type 2 patients 2

3 Consider use of continuous subcutaneous insulin infusion in insulin-treated patients with type 2 diabetes mellitus 2007 American Association of Clinical Endocrinologists Medical Guidelines For Clinical Practice for the Management of Diabetes Mellitus The efficacy and safety of CSII with an insulin pump are comparable to multiple daily injection insulin therapy for patients with type 2 diabetes mellitus 2007 American Association of Clinical Endocrinologists Medical Guidelines For Clinical Practice for the Management of Diabetes Mellitus AACE Diabetes Mellitus Guidelines. Endocr Pract. 2007;13(suppl 1):

4 Tight Glycemic Control Decreased the Risk of Diabetes-Related Complications in UKPDS In 3,867 patients with type 2 diabetes in the UK Prospective Diabetes Study (UKPDS), intensive control of blood glucose was associated with a decreased risk for complications Intensive management achieved significantly lower median A1C levels compared to conventional treatment* *Median follow-up in the UKPDS study was 10 years UKPDS Group. Lancet. 1998;352:

5 Breaking Glucose Toxicity Case Study of 55 Year Old Woman Frequent administration of analog insulin (every 2 hours for 11 days) Notable reduction in glucose toxicity and insulin requirements Raine, CH et,al. J Natl Med Assoc 1999;91:

6 CSII Helps Reduce A1C in Type 2 Patients Randomized Crossover Design: 48-week study 40 obese patients with type 2 diabetes previously treated with MDI plus metformin Insulin Pump Therapy: Significantly reduced A1C levels Lowered meal glucose values Contributed to reduction of daily insulin requirement CSII 0.8% Reduction In A1C MDI 0.4% Increase In A1C Wainstein J, et al. Diabet Med. 2005; 22:

7 CSII Can Produce Greater Reductions in A1C Compared with Multiple Daily Injections Mean A1C in T2DM patients treated with MDI or CSII (Continuous Subcutaneous Insulin Infusion) In a randomized, crossover study in 17 patients with type 2 diabetes, CSII decreased A1C significantly more than MDI Berthe E, Lireux B, Coffin C, et al. Horm Metab Res. 2007; 39: Wainstein J, Metzger M, Boaz M, et al. Diabet Med. 2005; 22:

8 CSII Helps Reduce Daily Insulin Requirements in Type 2 Patients Patient 1 Patient 2 Patient 3 Patient 4 Before CSII 630 u/day 402 u/day 218 u/day Insulin Post 1-Yr CSII Use 111 u/day 315 u/day 81 u/day Before CSII 10.3% 10.4% 7.5% A1C Post 1-Yr CSII Use 5.7% 7.6% 6.2% Patient 4 is not included in this analysis because he was not on CSII for 1 year. Neilsen et al., Diabetes Educator 2005 Vol. 31 8

9 CSII Does Not Promote Weight Gain in Type 2 Patients While reducing A1C and insulin requirements Time (weeks) 0 40 P Weight (lb) <0.05 A1C 12.34% 10.2% <0.05 Units/lb <0.05 Wainstein J: Diabetologia. 2000; 43(suppl. 1):789. 9

10 CSII Effectively Manages Postprandial Hyperglycemia * P <0.001, CSII vs MDI P <0.01, CSII vs conventional insulin therapy and CSII vs MDI P <0.01, CSII vs conventional insulin therapy and MDI vs conventional insulin therapy P <0.001, CSII vs conventional insulin therapy and MDI vs conventional insulin therapy Hyperglycemia is a major Contributor to A1C and the Development of Macrovascular complications In a randomized, crossover study in 17 patients with type 2 diabetes, CSII was associated with better pre- and post- breakfast blood glucose control compared with MDI Berthe E, Lireux B, Coffin C, et al. Horm Metab Res. 2007; 39:

11 CSII Is Associated with Improved Patient Satisfaction Compared to MDI In a multicenter, randomized 24-week trial in 132 CSII-naïve patients with type 2 diabetes mellitus, patient satisfaction scores for convenience, ease of use, and overall satisfaction were significantly higher with CSII than with MDI In addition, 93% of patients using CSII preferred the pump to their previous injectable insulin regimen Raskin P, et al. Diabetes Care. 2003; 26:

12 Benefits of Insulin Pump Therapy for Patients with Type 2 Diabetes Improved glycemic control Reduced risk of complications Enhanced quality of life A1C Improved patient satisfaction Ease of management 12

13 Not Every Patient that Presents Like a Type 2 is a Type 2 LADA Latent Autoimmune Diabetes in Adults Presence of antibodies, hence disease state very similar to Type-1 patients Little to no insulin resistance (insulin sensitivity normal) Not insulin requiring, at least during the first 6 months Oral agents fail earlier Beta-cell failure earlier than classic type 2 Typically multiple islet antibodies = beta cell failure within 5 years Only GAD or islet cell antibodies = beta cell failure after 5 years Gunner, et al., Diabetes. 2005; 54:S68-S72. 13

14 Medtronic Diabetes Devonshire Street Northridge, CA