Best Evidence Analyses and Commentary

The use of insulin pumps to control blood sugar in persons with diabetes is rising; an estimated 375,000 people use them worldwide.1  Insulin pump use in patients with type 2 diabetes is also increasing, with more patients relying on insulin therapy for control every day.  With the rise in use, many insurance companies are starting to cover insulin pumps and supplies.  Coupled with data that shows fewer complications with tight blood sugar control, insulin pumps can be beneficial in certain patients with diabetes requiring insulin therapy.2 

Insulin pumps work by providing a constant flow of rapid acting insulin (Humalog®, Novolog®, or Apidra®) into the patient’s body.  The flow of insulin is adjusted by the patient’s healthcare provider, taking into consideration the patient’s daily insulin need as well as insulin sensitivity.  Most pumps also allow for short bursts (boluses) of insulin to be administered to cover for mealtime increases in blood sugar. 

There are a variety of insulin pumps available.  Each provides different benefits and pitfalls to their use, making it difficult for both a patient and their healthcare provider to choose which pump is right for them. 

It is important to consider all features of a pump before choosing one for a patient.  Price is often a deciding factor for most patients.  Often, it is difficult to price pumps for individuals since most insurance companies have contracted prices for each pump.  The  cash price for most pumps usually ranges from $5,000 - $7,000.  This cost is for the pump alone.  Most insulin pumps require infusion sets and tubings that cost around $12 each.  These sets need to be changed ever 2-3 days, which adds to the cost for the patient.  All of the pumps and infusion sets are similarly priced.  As an alternative, the OmniPod tubeless pump system can be purchased for ~$600 but requires the tubeless system to be purchased for ~$35 each. 

The OmniPod system is marketed as a tubeless insulin pump.3  It uses a Personal Diabetes Manager (PDM) device, similar to a PDA or a smart phone, to communicate wirelessly with a waterproof, tubeless, “pod” that is placed on the body.  The pod has an automatic inserter to place a catheter under the skin of the patient to deliver the insulin.  The PDM is programmed with a set rate to deliver insulin to the patient.  The patient can also program a bolus amount of insulin to cover meals.  Once programmed, the PDM can be placed in a drawer or bag while the pod automatically delivers the scheduled amount of insulin.  This allows for freedom from carrying the insulin pump device with attached tubing.  The PDM however does need to be within 2 feet of the pod when communicating changes in insulin doses.  The pod is also a bit larger than other infusion sets, which can make it visible through clothing and bulky when physically active. 

The PDM also has a number of applications that help the patient calculate the necessary amount of insulin to cover blood sugars and meals.  It has a built in glucometer and food library to help with these calculations.  It also integrates with many different available continuous glucose monitoring (CGM) systems, that must be purchased separately, which can reduce finger sticks throughout the day. 

The One Touch Ping is the most recently available insulin pump from Animas4.  It is a waterproof insulin pump.  The Ping, much like the OmniPod, has a meter remote that communicates wirelessly with the pump.  This remote also has applications and can remotely dose insulin from the pump.  The Ping can interface completely with a CGM system, purchased separately, as well. 

The Medtronic MiniMed Paradigm offers completely integrated CGM with their extra accessories.  The patient can purchase a glucose sensor that is placed in the skin to continuously monitor blood glucose.  This information is directly transmitted to the MiniMed and can warn patients of impending highs and lows.  Although water resistant, the company does not recommend that the patient bathe or swim with the pump attached.   Unlike the units above, this unit lacks a food library to help the patient calculate mealtime insulin doses.

The amount of insulin a pump can hold and the minimum and maximum amounts that they can dose are important factors.  The MiniMed holds the most insulin, 300 units.  Both the OmniPod and Ping can hold at most 200 units.  Larger volumes allow for more time in between filling the pumps’ reservoirs (for people travelling or working long hours).   

The OmniPod can dose in increments of 0.5 units. The Ping and MiniMed both can dose at increments of 0.25 units, giving better ability to control blood sugar.  The maximum amount that the Ping, OmniPod, and MiniMed can dose at one time are 25, 30, and 35 units respectively.  Larger maximum doses can be less time consuming for patients, especially those type 2 patients who might need large amounts of insulin per dose. 

Most insulin pumps interact with home computers to give the patient access to graphs and other data collected.  This data can then be taken to a doctor’s office for analysis.  Both the Ping and MiniMed are PC and Mac compatible.  The OmniPod’s software is only PC compatible. 

There are a number of other insulin pump systems available in the United States.  The ones mentioned are the more common pumps.  When choosing the right one, each patient’s individual situation must be taken into account.  Working with the patient to choose the best system for them can give the patient new freedoms their diabetes may have restricted them from experiencing and can have a major impact on the patient’s overall quality of life.   

 

References: 

1.     1.  Skyler JS, Ponder S, Kruger DF, Matheson D, Parkin CG. Is there a place for insulin pump therapy in your practice? Clin Diabetes. 2007 Apr;25(2):50–6. 

2.     2. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977–86. 

3.    3Insulet Corporation. Insulin Pumps – Insulin Pump Therapy [Internet]. Bedford (MA); 2011 [cited 2011 Aug 30]. Available from: http://www.myomnipod.com/. 

4.    4. Animas Corporation. Insulin Pumps and Insulin Pump Therapy – Animas [Internet]. 2007 [updated 2011 Sep 26; cited 2011 Aug 30]. Available from: http://www.animas.com. 

5.     5. Medtronic, Inc. Medtronic Diabetes [Internet]. 2011 [cited 2011 Aug 30]. Available from: http://www.minimed.com/.


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