Insulinepomp met glucosesensor: STAR 3 studie

Insulinepomp met glucosesensor bij slecht ingestelde DM type 1 patiënten. Primair eindpunt is verandering van HbA1c  ten opzichte van baseline

De auteurs concluderen dat 'significant meer DM type 1 kinderen en volwassenen, die slecht waren ingesteld, de beoogde HbA1c bereiken met behulp van insulinepomp met glucosesensor therapie in vergelijking met recombinant insuline analogen therapie'.

Background: Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors.

Methods: In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams. The primary end point was the change from the baseline glycated hemoglobin level.

Results: At 1 year, the baseline mean glycated hemoglobin level (8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group, as compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached the glycated hemoglobin target (<7%) was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group.

Conclusions: In both adults and children with inadequately controlled type 1 diabetes, sensor-augmented pump therapy resulted in significant improvement in glycated hemoglobin levels, as compared with injection therapy. A significantly greater proportion of both adults and children in the pump-therapy group than in the injection-therapy group reached the target glycated hemoglobin level.

International Diabetes Center at Park Nicollet, Minneapolis, US
Bergenstal R

SOURCE: NEJM 2010; 363(4): 311-320