Unique trial compares insulin pump to MDI treatment in type 1 diabetes

The first-ever randomised controlled trial has compared the effectiveness of insulin pump therapy and multiple daily injections (MDI) in adults with type 1 diabetes who received structured diabetes education.
Scientists from the University of Sheffield found that both therapies led to similar improvements in HbA1c, rates of severe hypoglycemia and improvements in psychological measures, although insulin pump users experienced more dietary freedom and less daily hassle.
The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial randomised 317 people with type 1 diabetes to pump or MDI therapy, with both groups receiving similar structured diabetes education. The participants were then followed for two years.
While both groups showed improved quality of life benefits and health markers, those using pumps had slightly greater HbA1c decreases, fewer diet restrictions and treatment satisfaction.
HbA1c levels improved by 9.3 mmol/mol (0.85%) in the insulin pump group and by 4.5 mmol/mol (0.42%) in the MDI group.
“People with type 1 diabetes might be better served by ensuring far greater availability of high quality, structured self-management training, which is currently only accessed by around 10% of adults in the UK,” said the researchers.
The researchers also noted that patients who receive structured diabetes education before adopting insulin pump treatment are more likely to benefit from insulin pump therapy and meet recommended HbA1c targets.
“Participants might only recognise the limitations of insulin delivery by multiple daily injections if they start actively managing their diabetes after training,” they said.
“Those individuals could then be offered pump treatment to help them reach the stringent glucose targets necessary to achieve an HbA1c of 6.5% or to overcome problematic hypoglycemia.”
The findings appear online in The BMJ.