We were disappointed with some of the headlines associated with a story on insulin pump use in teens that came out yesterday. The story was on an FDA review published in the journal, Pediatrics, on the risks of insulin pump use over 10 years (1996-2005) that found “13 deaths and more than 1500 injuries connected with pumps.” These were attributed both to device malfunctions as well as human judgment error.
What the AP did:
• Wrote an article on the top-line data from the study
• Described insulin pumps
• Distinguished between type 1 and type 2 diabetes
• Quoted Dr. John Buse (president of the American Diabetes Association), Dr. Judith Cope (lead author in the FDA analysis), Dr. Christina Luedke (Children’s Hospital, Boston) on their views on insulin pumping.
What the AP did right:
• Emphasized the importance of careful screening before starting children/teens on pumps – for doctors and educators, patient selection is key, and for patients, understanding the power of the therapy is really important
• Called on parents to be vigilant regarding pump use in their children
• Lauded the benefit of pumps by freeing kids from the pain/anxiety/stigma sometimes associated with injections
• Reported early in the story that the FDA study was NOT advising against the use but simply calling for more study on safe use of pumps in pediatric populations (although some headlines would have us think otherwise!)
• Mentioned the difficulty for teens (for anyone!) of good glycemic management with (multiple daily) insulin injections
What the AP forgot (in our view):
• Did not report on any of the dangers of the alternatives to pumps – for example, there are many problems that stem from MDI (multiple daily injections), such as diabetic ketoacidosis (DKA) and/or severe hypoglycemia – it would have been great to have this acknowledged in the article. Pumps enable the ability to deliver more physiologic therapy - a winner for many patients and for many, an enabler to better diabetes management.
• While it is true that mechanical devices can malfunction, we believe that real-life data would show this can be avoided - the 24/7 hotlines have enabled great advice to pump users and have given patients a feeling of well-being because they know they can call if they need to. Although I never use customer service (I virtually never have issues with my pump), I like knowing that it is there. While user error with pumps can occur, this goes back to patient selection, education, and training - indeed, user error can occur with any application of insulin! (An aside: why doesn’t someone write an article about how more diabetes education is needed and about how we need to prevent complications, not just treat them!)
• We believe that there should have been more emphasis on the fact that insulin pumping and glucose monitoring go hand in hand and that monitoring is very important in order to avoid any serious adverse event occurs.
Final thoughts
Dr. Francine Kaufman raised an excellent point when we spoke to her about this: “How many adverse events are there with MDI or traditional therapy! How many go unreported?" She emphasized that there are more under-reported adverse events with MDI and that more are reported with pump therapy. She stressed, "Done correctly, there is a real benefit perceived by patients, families, and pediatric endocrinologists and endocrinologists related to pump therapy ... A number of trials and studies have shown that in the right patients, with adequate education and patient support, pump therapy can be a major advantage.”
Virtually every trial done, for example, shows benefits related to hypoglycemia. And that alone is enough for me! I'll end by pointing you to a poignant piece written by Kerri Morrone on hypoglycemia, "this is exactly what hypoglycemia has been like for me and yet another reason I'm so grateful to my insurance company for covering my pump. There are many, many fewer moments that I spend in hypoglycemia due to my pump and many fewer due to my CGM. Though I can't thank all insurers yet for covering this, I do send big thanks to the inventors. "
