Swedish study on pumps v MDI

[LucySW]

New study here based on almost the entire Swedish T1 population:

... using patient data from the Swedish National Diabetes Registry from 1996 till 2014. The data included more than 95% of the Swedish type 1 diabetes population with 2,441 of the patients using insulin pumps and 15,727 on multiple daily insulin injections.

Study results showed that patients on insulin pumps had a 29% reduction in mortality rate compared to patients on multiple daily insulin injection. Patients on insulin pumps had 43% lower risk of fatal cardiovascular disease compared to those on insulin injections.​

 

[noblehead]

Interesting Lucy and more evidence on the worthiness of pump therapy.

I've long put off the thought of switching to a pump, but the more I read about members experiences on how it has given them more flexibility when it comes to food and exercise the more convinced I'm becoming that a pump may be the way forward.

 

[Robinredbreast]

, Yes I see what you mean, it does seem to look beneficial, but I am still on injections. When I had my accident and the complications that now goes with it, I am thinking I wouldn't of been able to manage a pump one handed/chronic pain, deformity of hand, or am I wrong and it would be possible ?

 

[noblehead]

, Yes I see what you mean, it does seem to look beneficial, but I am still on injections. When I had my accident and the complications that now goes with it, I am thinking I wouldn't of been able to manage a pump one handed/chronic pain, deformity of hand, or am I wrong and it would be possible ?

With the Omnipod pump I can't see how it would be a problem, but much like yourself I'm not a pump user.

 

[DunePlodder]

Could it be that the average pump user is more interested in & informed about their diabetes than the average MDI user?

 

[noblehead]

Could it be that the average pump user is more interested in & informed about their diabetes than the average MDI user?

I don't know, but there's more work involved in using a pump so that might be a factor. I think the small increments of insulin delivered solves a lot of problems.

 

[Robinredbreast]

Could it be that the average pump user is more interested in & informed about their diabetes than the average MDI user?

I am most certainly interested in my diabetes and I have done so for a 1/4 of a century now I am a MDI user

 

[DunePlodder]

I don't know, but there's more work involved in using a pump so that might be a factor. I think the small increments of insulin delivered solves a lot of problems.

I'm sure you are right about small increments. Like you I've never really liked the idea of a pump but something like the Omnipod is more appealing.

 

[noblehead]

I'm sure you are right about small increments. Like you I've never really liked the idea of a pump but something like the Omnipod is more appealing.

Me too, the tubing was always a concern of mine so the Omnipod would be ideal

 

[phoenix]

Thanks, Lucy.
I've just been listening to the webcast of the presentation.
http://www.easdvirtualmeeting.org/resources/18955

The Swedish Registry is a fantastic resource for ongoing studies and this one will continually update. There weren't really that many CVD endpoints because the average age was in the late 30s at the start of the study. These events will sadly but inevitably increase over time.
I think the point about confounding is an important one. Is there something different between those who use pumps and those that don't? This was discussed in the questions One thing brought up was about the extra education given to pump users and also the possibly better access to professional advice.
The study does of course only apply to this population. Type one was defined as having an onset at below 30 .

There are a lot of really interesting subjects with free webcasts.

 

[-Artemis-]

New study here based on almost the entire Swedish T1 population:

... using patient data from the Swedish National Diabetes Registry from 1996 till 2014. The data included more than 95% of the Swedish type 1 diabetes population with 2,441 of the patients using insulin pumps and 15,727 on multiple daily insulin injections.

Study results showed that patients on insulin pumps had a 29% reduction in mortality rate compared to patients on multiple daily insulin injection. Patients on insulin pumps had 43% lower risk of fatal cardiovascular disease compared to those on insulin injections.​

Sorry if I'm being slow... And I possibly don't want to know the answer being on MDI... :-(
- But why is the risk of a heart attack so much lower...?


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[AlexMBrennan]

Very curious, and pretty much the exact opposite of what I'd have expected given that, at least in the UK, pumps tend to be given to "difficult cases" and not people who achieve perfect control with MDI.

 

[LucySW]

But why is the risk of a heart attack so much lower...?

Because pumps let you get a lower, better HbA1c? That's how I read it.

 

[-Artemis-]

Because pumps let you get a lower, better HbA1c? That's how I read it.

... Ah, ok - makes sense.. I was worried its something about injecting / doses... Feel a little bit better now.

I know v little about pumps, and like some others have said, they don't appeal from a 'having something stuck to you' perspective - but - obviously that has to be weighed with overall health, so maybe I need to research a bit more...

But it also sounds like, overall - hbA1c is the crucial part, not whether you're on a pump or MDI's...?


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[chrisp1234]

Very curious, and pretty much the exact opposite of what I'd have expected given that, at least in the UK, pumps tend to be given to "difficult cases" and not people who achieve perfect control with MDI.

This is the exact opposite of how it seems to work for children with type 1 especially in our NHS area, we are encouraged to opt for a pump as soon as we can show good control with MDI for our kids.

I'm a parent with a child of 6 with Type 1 so the above sentence makes more sense

 

[the_exile]

Could it be that the average pump user is more interested in & informed about their diabetes than the average MDI user?

I would agree with this, for every 1 person that is fully committed on MDI you'll perhaps get 3 or 4 who aren't. While on a pump, you have to be on the ball or it won't work! Plus you can micro manage certain things which does help in the fine tuning of management of the condition.

 

[LucySW]

You can make much finer adjustments with the pump, isn't that true? (I'm not a pump user.)

 

[the_exile]

... Ah, ok - makes sense.. I was worried its something about injecting / doses... Feel a little bit better now.

I know v little about pumps, and like some others have said, they don't appeal from a 'having something stuck to you' perspective - but - obviously that has to be weighed with overall health, so maybe I need to research a bit more...

But it also sounds like, overall - hbA1c is the crucial part, not whether you're on a pump or MDI's...?


Sent from the Diabetes Forum App

I was given a pump as i had lost hypo awareness and it was thought that tighter control would hopefully give memy warnings back. Also, the idea is that long term they will save the NHS billions as long term complications reduce given how well people can manage their overall control.

Now, the only downside to having a pump is the fact you do indeed have a pump attached to you, there's no getting away from it, it's there constantly, when you're sleeping you can roll on top of it and it'll dig into your side, when you're getting dressed it'll catch on your tshirt and you'll certianly know about it! I've even got the tubing caught on a door handle before. But would I trade it in for MDI's again? Not a chance, the flexability is incredible, the tiredenss and fatigue I had on MDI's is gone and I feel like a new person.

Will they work for everyone? No, some will just refuse to have something attached to them 24/7, but I would recommed everyone gives them a go if given the opportunity.

 

[the_exile]

You can make much finer adjustments with the pump, isn't that true? (I'm not a pump user.)

goes up and down in 0.1 units.

 

[phoenix]

Very curious, and pretty much the exact opposite of what I'd have expected given that, at least in the UK, pumps tend to be given to "difficult cases" and not people who achieve perfect control with MDI.

That might not be the case in Sweden though. In France, I got my pump with relatively good control and a very low HbA1c but I did find it hard to preventing lows when running and hillwalking. The pump was ideal for this because of the infinitely flexible basal. Those on my pump course were a mixed bunch. I think we were all pretty proactive so I suspect that was one of the criteria.