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Insulin Pump Therapy for Type 1

Insulin Pump Therapy for Type 1. Objective Overview of the benefits of insulin pump therapy in management of type 1 diabetes Key Points Benefits of Insulin Pump Therapy: Reduction A1C Reduction of incidents of severe hypoglycaemia Indications for insulin pump therapy for type 1 patients.

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Insulin Pump Therapy for Type 1

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  1. Insulin Pump Therapy forType 1

  2. Objective Overview of the benefits of insulin pump therapy in management of type 1 diabetes Key Points Benefits of Insulin Pump Therapy: Reduction A1C Reduction of incidents of severe hypoglycaemia Indications for insulin pump therapy for type 1 patients

  3. CSII is Safe and Beneficial in Paediatric Patients with Diabetes • Paediatric consensus statement: • “CSII is the most physiological method of insulin delivery currently available” Phillip M, et al. Diabetes Care. 2007;30:1653-1662.

  4. Multiple Insulin Regimens for Diabetes Variability in Action/Peak/Absorption

  5. Insulin Pumps Use Only Rapid-Acting Insulin Pharmacodynamic Variability in Insulin Action* Intermediate-acting insulin Long-acting insulin 46% Rapid-acting insulin 36% 16% *Percentages represent the coefficients of variation (CV) for insulin action as measured by the maximum glucose infusion rate in these euglycaemic glucose clamp studies Rapid-acting insulin has the lowest intrapatient variability Heinemann L, et al.Diabetes Care. 1998;21:1910–1914; Heise T, et al. Diabetes. 2004; 53:1614-1620.

  6. Long Acting and Intermediate Acting Insulin Can Have Similar Variability Scholtz He et al., Diabetologia 1999, 42(Suppl):A235. Abstract 882.

  7. Basal Insulin Needs Vary Throughout the Day Results indicate it is not reasonable to expect basal insulin needs to be met by a flat rate of insulin delivery for 24 hours. Scheiner G et al. Diab Res and Clin Prac. 2005;69(1):14-21.

  8. mg/dL 126 108 90 72 CSII Controls Dawn Phenomenon by Allowing Multiple Basal Rates • In 10 patients with type 1 diabetes and demonstrated dawn phenomenon, adjusting the overnight insulin infusion rates abolished dawn phenomenon and significantly decreased the plasma glucose levels to match healthy controls. Koivisto VA et al. Diabetes. 1986; 35: 78-82.

  9. In the 5-Nations Study, CSII Was Superior to MDI for Reducing A1C in Patients with Type 1 Diabetes Hoogma RP et al. Diabet Med. 2006;23:141-147. Reused with permission.

  10. CSII Improves A1C Compared with MDI A meta-analysis of 52 studies (1,547 patients) shows that CSII is significantly more effective in lowering A1C compared to MDI and conventional insulin therapy (MD 0.95) Bruttomesso D, et al. Diabet Med. 2002;19(8):628-634. Bell DSH, et al. Endocr Pract. 2000;6(5):357-360. Rudolph JW, et al. Endocr Pract. 2002;8(6):401-405. Chantelau E, et al. Diabetologia. 1989;32(7):421-426. Boland EA, et al. Diabetes Care. 1999;22(11):1779-1784. Maniatis AK, et al. Pediatrics. 2001;107(2):351-356. Litton J, et al. J Pediatr. 2002;141(4):490-495 Weissberg-Benchell J, et al. Diabetes Care 2003; 26 : 1079-1087

  11. CSII Reduces Incidents of Severe Hypoglycaemia Adapted from Bode BW, et al., Diabetes Care 1996, 19:325-327. Boland EA, et al. Diabetes Care. 1999;22(11):1779-1784 Rudolph JW, et al. Endocrine Practice 2002: 8(6); 401 - 405

  12. CSII Use Does Not Increase Risk of DKA • DeVries JH et al; Diabetes Care 2002 M. Dur = 32 weeks, n = 79, Mean Age = 36.5 • No change compared to MDI: 1 episode during study Plotnick LP et al; Diabetes Care 2003; 26 (4):1142-1146 Bruttomesso D.; Diabetic Medicine 2002; 19 (8):628-634 Linkeschova R et al. Diabetic Medicine 2002; 19:746-751 DeVries JH et al; Diabetes Care 2002; 25 (11):2074-2080 Steindel BS et al. Diabetes Res Clin Pract. 1995; 27(3):199-204

  13. Who are unable to achieve acceptable control using multiple daily injections (MDI) With histories of frequent hypoglycaemia and/or hypoglycaemia unawareness Who are pregnant With extreme insulin sensitivity With a history of dawn phenomenon Who require more intensive diabetes management because of complications including neuropathy, nephropathy, and retinopathy Using MDI who have demonstrated willingness and ability to comply with prescribed diabetes self-care behavior, including frequent glucose monitoring, carbohydrate counting, and insulin adjustment 2007 AACE Guidelines for Clinical Practice For type 1 diabetes, insulin pump therapy is indicated for patients: Rodbard HW, Endocrine Practice 2007;13(suppl 1):1-68

  14. Professional Guidelines and Recommendations for Use of Insulin Pump Therapy 2007 American Association of Clinical Endocrinologists (AACE) Clinical Guidelines For Managing Diabetes Mellitus 2007 Consensus Statement on Use of Insulin Pump Therapy in the Pediatric Age-Group Endorsed by American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) 2006 American Academy of Pediatrics Position Statement on Use of Insulin Pump Therapy in Very Young Children With Type 1 Diabetes

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