Insulin Pump Improves Glucose Levels in Patients with Type 2 Diabetes

Patients with type 2 diabetes who were treated with an automated insulin delivery (AID) system showed a significantly greater reduction in glucose levels compared to patients who received usual care plus continuous glucose monitoring, according to a recent clinical trial published in the New England Journal of Medicine.  

Grazia Aleppo, MD, professor of Medicine in the Division of Endocrinology, Metabolism and Molecular Medicine, was a co-author of the study and principal investigator of the Northwestern Medicine clinical study site.  

More than 38 million Americans currently have diabetes, and more than 90 percent of those have type 2 diabetes, according to recent data from the Centers for Disease Control and Prevention.  

AID systems, more commonly known as insulin pumps, are widely known to benefit patients with type 1 diabetes, which help improve glycated hemoglobin levels as well as time spent in the target glucose range (70 to 180 milligrams per deciliter). The device automatically adjusts the amount of insulin delivered based on an algorithm driven by continuous monitoring of the patient’s glucose levels.  

According to the Centers for Disease Control and Prevention, insulin is prescribed within one year after diagnosis in 12.3 percent of patients with type 2 diabetes, in addition to other treatment options, such as GLP-1 receptor agonists and sodium–glucose cotransporter 2 (SGLT2) inhibitors, which help regulate blood glucose levels. The benefit of AID in patients with type 2 diabetes who are treated with insulin, however, had not yet been fully studied.  

In the current multi-center trial, a total of 319 adult patients with insulin-treated type 2 diabetes at 21 study sites across the U.S. and Canada were randomly assigned in a 2:1 ratio to receive an AID system or to continue their respective insulin-delivery method for 13 weeks. Both groups received continuous glucose monitoring; 39 percent of the enrolled patients were part of a racial or ethnic minority group.  

After 13 weeks, the investigators found that the AID group demonstrated a higher decrease in glycated hemoglobin levels (0.9 percentage points) compared to the control group (0.3 percentage points).  “That’s a very big result,” Aleppo said. “It’s not only comparable to the studies done in type 1 diabetes, it’s better.”  

Additionally, the percentage of time that patients spent in the target glucose range increased in the AID group, from 48 percent to 64 percent, compared to an increase of just 51 percent to 52 percent in the control group.  

Aleppo noted another interesting finding was that patients who received an AID demonstrated improved in glucose levels whether or not they used carbohydrate counting to manage mealtime insulin doses and optimize their glucose levels.  

“What this means is you don’t have to be able to count carbs to do well, which is again one more thing that people with type 2 diabetes might have challenges with,” Aleppo said.  

Aleppo also noted that not everyone may be able to use an AID — older patients with type 2 diabetes who could benefit from AID may also have dexterity issues — and that clinicians should be aware of these potential limitations and ensure proper training.  

The findings suggest a potential shift in treating patients with type 2 diabetes who are currently receiving insulin and may address gaps in current diabetes care, especially for patients who are on Medicare or Medicaid, according to Aleppo.  

“Many patients do very well with long-acting insulin, SGLT2 inhibitors and GLP-1 receptor agonists, especially if they’re seen early in their condition, but with time they will progress to beta cell failure. So, why not give an AID to a patient who needs insulin therapy, a system that not only helps them to do better but also reduces this continuous involvement of remembering to take insulin injections many times per day,” Aleppo said.  

This work was supported by Tandem Diabetes Care.