Are insulin pumps really related to increased mortality risk?

Recently, a group of journalists published the results of an investigation on medical devices. Part of the results of this investigation focused on the risks associated with the use of insulin pumps for the treatment of diabetes. According to these data, insulin pumps can lead to potentially serious injuries and even to cases of mortality often related to hypoglycemic episodes (low blood sugar level).

Given the concern expressed by many people living with diabetes and their families, the BETTER project team, which is studying new technologies in the treatment of diabetes and the prevention of hypoglycemia, wishes to put in context the remarks made in the CBC article.

What is an insulin pump?

Compared to insulin injections via a pen-injector or syringe, an insulin pump allows greater flexibility in insulin delivery, which better mimics insulin secretion from the pancreas of people without diabetes.

An insulin pump is an injection device that allows continuous infusion of insulin directly under the skin. It is not a completely automated system. Thus, the user must determine the doses of insulin to be administered. Therefore, all people who use an insulin pump should receive extensive and ongoing training to take into account a multitude of factors that influence blood glucose (diet, physical activity, illness, stress, etc.) and adjust doses of insulin accordingly.

Reliable scientific studies have shown that, compared to insulin injections, the insulin pump allows, for many people, better control of blood sugar levels and decreases the risk of severe hypoglycemia. On the other hand, the disadvantages identified include the need for training and support to use this technology, the costs, the discomfort of wearing the pump, the fear of hypoglycemia and a risk of device failure. The choice to use an insulin pump depends on many factors and is often considered when people living with diabetes cannot control their blood glucose with injections.

A word on the data reported in the article.

We believe that one of the most complete and documented answer was written by a group of patients (Connected in Motion), here are some key points:

  • The survey does not directly compare the risks of using insulin pumps with those of alternative solutions (injections), leaving the reader with a skewed view of the risks of living with type 1 diabetes in general.
  • The situations reported in the article are based on inconclusive and often incomplete evidence. Also, there is no mention of the dozens of other factors that influence blood glucose that must constantly be considered.
  • The vast majority of reported incidents, including death, were not causally related to the use of the insulin pump. Wearing a pump at the time of death does not necessarily mean that death is related to a malfunction with the pump.

Documenting side effects

The investigation points to the need to document side effects, as well as elements required to determine if they are related to the medical device. Available data suggest that insulin pump dysfunctions can cause serious consequences, but are rare events that need to be better tracked and studied.

The importance of knowing one’s condition

Although improved treatments and technologies have the potential to reduce complications associated with diabetes and improve quality of life, there is still a possibility for people living with type 1 diabetes to die from severe hypoglycemia or ketoacidosis (extreme hyperglycemia). However, the occurence is very rare but, unfortunately, still a reality, whether treated with an insulin pump or injections. Therefore, thorough knowledge of diabetes and its treatment is desirable for all people living with diabetes.

References:

  • Misso ML, Egberts KJ, Page M, O’Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010(1):CD005103.
  • Payk M, Robinson T, Davis D, Atchan M. An integrative review of the psychosocial facilitators and challenges of continuous subcutaneous insulin infusion therapy in type 1 diabetes. J Adv Nurs. 2018;74(3):528-538
  • Thabit H, Hovorka R. Continuous subcutaneous insulin infusion therapy and multiple daily insulin injections in type 1 diabetes mellitus: a comparative overview and future horizons. Expert Opin Drug Deliv. 2016;13(3):389-400.