AACE/ACE Consensus Statement on Insulin Pump Management
AACE/ACE Consensus Statement on Insulin Pump Management
Insulin pumps are advancing in form as well as function. For many years, they were simply miniature syringe pumps, with all of the pitfalls associated with these devices. Although complex, insulin pumps are now easier and safer to use. Insulin dose calculators ("wizards") are standard features of all current pumps; these improve dosing consistency and may decrease the frequency of insulin "stacking" (i.e., administering an insulin bolus while a recent prior bolus is still active). However, it is important to recognize device-specific recommendations may differ among patient scenarios. Therefore, prescribers should be familiar with these differences and train patients appropriately.
In the past, innovations in pump therapy were primarily cosmetic (e.g., availability in multiple colors) or incremental (e.g., allowing the storage of a customized series of basal rates or "profiles" to assist the user in adjusting pump settings to different life conditions). Insulin pumps are now following the lead of consumer electronics and have introduced features such as color touch screens, USB-rechargeable batteries, prefilled insulin cartridges, and disposability.
The availability of multiple infusion set types, various catheter tubing lengths, and tubeless pumps (where the infusion set and reservoir are integrated) have enhanced the acceptability of pump therapy and led to increased pump usage. Clinical trials are underway to validate methods that accelerate insulin action. These include the addition of hyaluronidase to the tubing, heating of the injection site, intradermal insulin injection, and new formulations of rapid-acting insulin. Data that support the feasibility of locating infusion sets and continuous glucose monitoring (CGM) catheters in close proximity make it likely that combination sensor and infusion sets will be developed, which will further increase patient convenience.
Improved connectivity to other devices is another area of rapid improvement. For many years, insulin pumps have received data transmitted from glucose meters. Insulin pumps can now display data from a CGM on the same screen and share data for display on other remote devices. This feature is likely to become more common in the next few years. Ultimately, insulin pumps may send data continuously to the "Cloud." However, currently most require a computer connection.
In 2013, the FDA approved Medtronic's MiniMed 530G with Enlite, under its new Artificial Pancreas Device System-Threshold Suspend guidelines, as the first device that alters insulin delivery in response to CGM sensor data. The pump features "threshold suspend," meaning that when CGM sensor glucose levels decline below a specified threshold, the pump alarms and suspends insulin delivery for 2 hours (or until the suspension is manually overridden). The use of this device has been shown to reduce nocturnal hypoglycemia.Table 1 shows a comparison of major insulin pumps, and Table 2 shows the characteristics of V-Go, a new type of disposable insulin delivery device for T2DM.
2. State of Insulin Pump Technology
Insulin pumps are advancing in form as well as function. For many years, they were simply miniature syringe pumps, with all of the pitfalls associated with these devices. Although complex, insulin pumps are now easier and safer to use. Insulin dose calculators ("wizards") are standard features of all current pumps; these improve dosing consistency and may decrease the frequency of insulin "stacking" (i.e., administering an insulin bolus while a recent prior bolus is still active). However, it is important to recognize device-specific recommendations may differ among patient scenarios. Therefore, prescribers should be familiar with these differences and train patients appropriately.
In the past, innovations in pump therapy were primarily cosmetic (e.g., availability in multiple colors) or incremental (e.g., allowing the storage of a customized series of basal rates or "profiles" to assist the user in adjusting pump settings to different life conditions). Insulin pumps are now following the lead of consumer electronics and have introduced features such as color touch screens, USB-rechargeable batteries, prefilled insulin cartridges, and disposability.
The availability of multiple infusion set types, various catheter tubing lengths, and tubeless pumps (where the infusion set and reservoir are integrated) have enhanced the acceptability of pump therapy and led to increased pump usage. Clinical trials are underway to validate methods that accelerate insulin action. These include the addition of hyaluronidase to the tubing, heating of the injection site, intradermal insulin injection, and new formulations of rapid-acting insulin. Data that support the feasibility of locating infusion sets and continuous glucose monitoring (CGM) catheters in close proximity make it likely that combination sensor and infusion sets will be developed, which will further increase patient convenience.
Improved connectivity to other devices is another area of rapid improvement. For many years, insulin pumps have received data transmitted from glucose meters. Insulin pumps can now display data from a CGM on the same screen and share data for display on other remote devices. This feature is likely to become more common in the next few years. Ultimately, insulin pumps may send data continuously to the "Cloud." However, currently most require a computer connection.
In 2013, the FDA approved Medtronic's MiniMed 530G with Enlite, under its new Artificial Pancreas Device System-Threshold Suspend guidelines, as the first device that alters insulin delivery in response to CGM sensor data. The pump features "threshold suspend," meaning that when CGM sensor glucose levels decline below a specified threshold, the pump alarms and suspends insulin delivery for 2 hours (or until the suspension is manually overridden). The use of this device has been shown to reduce nocturnal hypoglycemia.Table 1 shows a comparison of major insulin pumps, and Table 2 shows the characteristics of V-Go, a new type of disposable insulin delivery device for T2DM.
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