Insulin pumps offer no real benefit compared to multiple injections before systematic education in people with type 1 diabetes

  • Researchers from University of Sheffield and Sheffield Teaching Hospitals among first to compare effectiveness of traditional methods in managing type 1 diabetes with alternative technologies
  • Findings reveal that insulin pumps alone do not significantly improve quality of people’s lives
  • Until now, little research has been done to see how effective insulin pumps are compared with injections

Insulin pumps do not take away the need for vital education on diabetes self-management and were no more effective than injections in helping adults with type 1 diabetes control their blood sugar levels, reports new NIHR-funded research.

The REPOSE trial, funded by the NIHR and led by Professor Simon Heller of the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, found that barriers to successful diabetes control cannot be overcome by providing additional technology in the form of insulin pumps.

The research has been published in The British Medical Journal and Health Technology Assessment.

Type 1 diabetes is a lifelong condition affecting around 250,000 people in the UK. It occurs when the immune system destroys the cells that make insulin – the hormone needed to control blood sugar levels.

Many people with type 1 diabetes struggle to achieve blood sugar level targets and a significant proportion go on to develop serious complications, reducing the length and quality of their lives.

To minimise potentially life-threatening complications caused by high blood sugars, patients take multiple daily shots of insulin and as the body is no longer to produce the insulin itself, the dose must be adjusted to fit with regular food intake and exercise.

Alongside this, patients attend the Dose Adjustment For Normal Eating (DAFNE) educational programme. This has been shown to improve diabetes control, reduce risks of low blood sugars and improve quality of life.

However, newer forms of technology, including insulin pumps which continuously supply insulin using a device that sits under the skin, are becoming more widely available, with six per cent of adults with type 1 diabetes estimated to insulin pumps, a figure that rises to 40 per cent in the US.

The use of pumps is expensive, but can provide patients with a more flexible way of delivering their insulin. Until now, little research has been done to see how effective the pump is compared with injections.

During the research Professor Heller and his team allocated 267 participants (at eight centres across England and Scotland) onto a week-long educational course to learn about flexible insulin therapy, and split them into two groups. One group also received training on how to use a pump to deliver their insulin while the second group used multiple insulin injections for two years.

Although, participants using the pumps were more satisfied with the treatment, the findings reveal that there were no significant benefits in quality of life between those using insulin pumps and those taking daily shots of insulin.

Professor Simon Heller, Research and Development Director of Sheffield Teaching Hospitals and Professor of Clinical Diabetes at the University of Sheffield, said: “Offering pumps to adults whose blood glucose levels are high and who have not yet received training in insulin self-management doesn’t appear to offer additional benefit.

“What the results do suggest is that ensuring people receive training to enable them to better manage their diabetes is likely to be more beneficial. Pumps may be useful in patients who are highly engaged in their own management, but find that the limitations of insulin treatment prevent them achieving their glucose targets.”

Andy BroomheadAndy Broomhead, 35, of Chapeltown, Sheffield, took part in the Repose trial. He believes education is the key when learning how to control type 1 diabetes: “Taking part in a DAFNE course as part of the REPOSE trial changed my life. DAFNE gave me the freedom, flexibility and confidence to manage my own Type 1 diabetes confidently for the first time in a decade. I now feel empowered to look after myself and it's made me feel more confident living with Type 1 diabetes every day.

“Whilst it can be hard to put up with checking my own blood glucose seven or eight times a day, calculating carbohydrate values and then deciding how much insulin I need to give myself for every meal, I know how important it is to get those things right. DAFNE has given me the skills I need to look after my own health and I'd encourage anyone who hasn't yet been on the course to do so.”

Dr Martin Ashton-Key, Scientific Director at the NIHR Evaluation Trials and Studies Coordinating Centre added “The findings of this NIHR-funded research will be of real value to patients with diabetes and clinicians in the NHS.”

The journal articles are available in The BMJ and Health Technology Assessment. The National Institute for Health Research (NIHR) is the research arm of the NHS.

Additional information

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University of Sheffield

With almost 27,000 of the brightest students from over 140 countries, learning alongside over 1,200 of the best academics from across the globe, the University of Sheffield is one of the world’s leading universities.

A member of the UK’s prestigious Russell Group of leading research-led institutions, Sheffield offers world-class teaching and research excellence across a wide range of disciplines.

Unified by the power of discovery and understanding, staff and students at the university are committed to finding new ways to transform the world we live in.

Sheffield is the only university to feature in The Sunday Times 100 Best Not-For-Profit Organisations to Work For 2017 and was voted number one university in the UK for Student Satisfaction by Times Higher Education in 2014. In the last decade it has won four Queen’s Anniversary Prizes in recognition of the outstanding contribution to the United Kingdom’s intellectual, economic, cultural and social life.

Sheffield has six Nobel Prize winners among former staff and students and its alumni go on to hold positions of great responsibility and influence all over the world, making significant contributions in their chosen fields.

Global research partners and clients include Boeing, Rolls-Royce, Unilever, AstraZeneca, Glaxo SmithKline, Siemens and Airbus, as well as many UK and overseas government agencies and charitable foundations.

Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield Teaching Hospitals is one of the UK’s largest NHS Foundation Trusts and one of the largest and busiest teaching hospitals. We have over 16,000 staff caring for over two million patients each year at our five hospitals and in the local community:
• The Royal Hallamshire Hospital
• The Northern General Hospital
• Charles Clifford Dental Hospital
• Weston Park Cancer Hospital
• Jessop Wing Maternity Hospital

We offer a full range of local hospital and community health services for people in Sheffield as well as specialist hospital services to patients from further afield in our many specialist centres. The Trust is recognised internationally for its work in neurosciences, spinal injuries, renal, cancer, transplantation, neurosciences and orthopaedics.

Thanks to the hard work and commitment of our staff and volunteers, Sheffield Teaching Hospitals NHS Foundation Trust has been given an overall rating of ‘Good’ by the Care Quality Commission (CQC) with many services rated as ‘Outstanding'.

This means the Trust is one of only 18 (out of 174 Trusts) to have achieved a Good rating in every one of the five domains which the Care Quality Commission use to rate a NHS organisation: Safe, Caring, Responsive, Well led, Effective
We are proud to be one of the top 20% of NHS Trusts for patient satisfaction and to have consistently high numbers of our staff and patients who would recommend the Trust for care and as a place to work.
The Trust is a recognised leader in medical research for bone, cardiac, neurosciences and long term conditions such as diabetes and lung disease. We also play a key role in the training and education of medical, nursing and dental students with our academic partners, including the University of Sheffield and Sheffield Hallam. The Trust is a recognised leader in healthcare innovation and is host to a number of national projects including the Perfect Patient Pathway Test Bed, Devices for Dignity, Yorkshire and Humber Genomics Centre as well as being a partner in the Working Together Vanguard and National Centre for Sports and Exercise Medicine.
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The National Institute for Health Research
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website


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