NIHR Signal Insulin Pumps Not Much Better Than Multiple Injections For Intensive Control Of Type 1 Diabetes

NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes

People with type 1 diabetes offered insulin pumps did not achieve better blood glucose control compared with those using multiple daily injections. Education remains important.
While both groups saw improvements in blood glucose levels and fewer hypoglycaemic episodes (very low blood sugar) over two years, only one in four participants met NICE blood glucose targets. Insulin pump users showed some modest improvements in satisfaction, dietary freedom and daily hassle.
All participants in this NIHR trial attended a training course on managing their insulin levels before randomisation. This is important because previously observed benefits from pump treatment might actually have been a reflection of the training given to them.
Currently just 10% of adults with type 1 diabetes access these training courses. These results support NICE guidelines around the restricted use of insulin pumps and suggest that training improves self-management of the condition. Efforts should therefore be made to encourage training uptake.
People with type 1 diabetes require lifelong treatment with insulin. Doses are adjusted according to food intake, physical activity, and blood glucose level. High or low blood glucose levels lead to serious short and long term complications, however, many people struggle to maintain blood glucose levels within the target range.
Insulin pumps are small devices, about the size of a mobile phone, that deliver a steady flow of insulin. They offer an alternative to multiple daily injections, and may also help people who are unable to achieve blood glucose control. They a Continue reading

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U.S. Diabetes Patients Are About to Get Some High-Tech Relief

User-friendly devices to replace old, ‘barbaric’ tools
‘This is a crossroads for diabetes technology:’ analyst
Diabetes devices may be having their iPhone moment.
For decades, the daily routine of diabetics involved painful needles, finger-pricking lancets and imprecise glucose meters. Now, manufacturers have begun incorporating the slick and consumer-friendly designs of Silicon Valley, linking to phones and other tech devices.
“This is a crossroads for diabetes technology,’’ said Raj Denhoy, an analyst at Jefferies in New York.
September marked a breakthrough in the U.S., as regulators approved the first glucose-monitoring system that doesn’t need a blood sample, the FreeStyle Libre by Abbott Laboratories. The new devices do away with fingerpricks, changing an unpleasant, several-times-a-day routine into quiet monitoring in the background through a sensor worn on the back of the upper arm.
Other companies have been left behind. Johnson & Johnson is closing its insulin-pump unit after failing to keep up with Medtronic Plc. DexCom Inc., the current leader in glucose-monitoring systems, lost a third of its market value on Sept. 28 after Abbott’s Libre got approval.
On DexCom’s earnings conference call Wednesday executives, peppered with questions about the Libre, said the company hopes to introduce its own fingerprick-free device before the end of 2018. The comments about next-generation monitors helped assuage investors’ concerns about DexCom’s prospects, sending the stock up 9.5 percent in the two trading days following the results.
“Companies who Continue reading

Diabetes Technology Moves Closer To Making Life Easier For Patients

For people with diabetes, keeping blood sugar levels in a normal range – not too high or too low – is a lifelong challenge. New technologies to ease the burden are emerging rapidly, but insurance reimbursement challenges, supply shortages, and shifting competition make it tough for patients to access them quickly.
One new product is a fast-acting insulin from Novo Nordisk. It is designed to help to minimize the high blood sugar spikes that often occur when people with diabetes eat a meal containing carbohydrates.
This new formulation, branded "Fiasp," adds niacinamide (vitamin B3), which roughly doubles the speed of initial insulin absorption compared to current fast-acting insulins taken at mealtime. This new insulin hits the bloodstream in under three minutes.
Another advance is Abbott's new monitoring device called the FreeStyle Libre Flash. It's new in the U.S. but has been available in Europe since 2014. It's a round patch with a catheter that is inserted on the arm for up to 10 days and a durable scanning device that the user waves over the patch to read the level of sugar in their tissues, which reflects the blood sugar level.
The Libre works a bit differently than the two currently available continuous glucose monitors (CGMs) made by Dexcom and Medtronic. The Libre doesn't require users to prick their fingers for blood tests to calibrate it, whereas users of the other monitors must perform twice-daily fingerstick calibrations.
Also, the Libre is approved for longer wear – 10 days (14 in Europe) versus seven days for the two current CGMs. And, it is likely to b Continue reading

The first ‘artificial pancreas’ systems are coming to market

The first so-called artificial pancreas systems – wearable devices that take charge of the crucial process of measuring glucose levels and delivering precise doses of insulin – are now beginning to come to market.
That’s welcome news for the nation’s 30 million diabetics, who stand not only to get some relief from the seemingly incessant stream of lancets, test strips and syringes, but also to stay healthier. That’s because an artificial pancreas can keep the disease on a tighter leash than they can, by testing more frequently and delivering more precise insulin doses.
That’s not only important for patients, but could ease strains on the nation's healthcare system.
This spring, Medtronic became the first supplier out of the gate when it began outfitting a pre-selected pool of type 1 diabetes patients with its new MiniMed 670G. Once that group is trained and equipped – probably by midyear – Medtronic expects to make the device more widely available.
Several efforts – including startup Bigfoot Biomedical, Insulet and a partnership between Dexcom, Tandem and TypeZero – are hot on Medtronic’s heels, with active studies now underway and plans to go to market late this year or in 2018.
Though the term artificial pancreas is widely used, medical professionals tend to steer clear because some patients hear it and think they’re in for an organ transplant. They’re not. An artificial pancreas doesn’t replace the actual organ. Devices aren’t implanted or surgically attached. Moreover, they only take over one of the organ’s digestive responsibilities: tha Continue reading

4 reasons why US health care is so expensive

(CNN)Health care spending in the United States increased by about $933.5 billion between 1996 and 2013, according to an analysis published Tuesday in the medical journal JAMA. More than half of this surge was a result of generally higher prices for health care services.
Joseph L. Dieleman, lead author of the study and an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, gathered information on 155 separate health conditions and six possible treatment categories: inpatient, outpatient (hospital), emergency services, dental care, prescriptions and nursing facilities.
The researchers also analyzed changes in five factors -- population size, aging, disease incidence, use of services, and service price and intensity -- as they relate to health care spending in the study period, 1996 through 2013.
"Intensity of care" refers to service variety and complexity. "It's the difference between a relatively simple X-ray as a compared to more complex MRIs and other forms of diagnostic services," Dieleman wrote in an email.
"Price and the variety and complexity of services is the largest driver of health care spending increases," Dieleman noted.
In fact, more than half of the total spending increase was due to price and intensity increases, which contributed $583.5 billion to the $933.5 billion total increase. Dieleman said price and intensity increased for most conditions "and especially for inpatient care."
By comparison, the growth in population led to $269.5 billion of the total expenditures, while aging of the population Continue reading