Will long acting insulin analogs influence the use of insulin pump therapy in type 1 diabetes?

Insulin pump therapy enjoys a steadily growing number of users and is associated with an approximately 0.5% lower A1c as compared to flexible insulin injection therapy in type 1 diabetes patients. An important question is whether superiority of insulin pump therapy persists in the era of rapid acting analogs and will persist in the era of long acting analogs. Pooled data of three randomized clinical trials using rapid acting analogs in both arms shows a 0.35% lower A1c when on the pump. Treatment effect was shown to be larger in those with higher baseline A1c's. Results of three trials comparing insulin pump therapy with regimens consisting of both rapid acting and long acting analogs are inconsistent, probably indicating the advantage of pump therapy at group level is likely to have become relatively small. Therefore, the challenge for the treatment team is to identify those patients who benefit most from insulin pump treatment. Poor glycemic control merits a trial of insulin pump therapy in the motivated patient. Other indications for insulin pump therapy include the need for several basal rates, a life style characterized by unpredictable physical activity and patient preference.