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Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes.
Bergenstal, Richard M. M.D.; Tamborlane, William V. M.D.; Ahmann, Andrew M.D.; Buse, John B. M.D., Ph.D.; Dailey, George M.D.; Davis, Stephen N. M.D.; Joyce, Carol M.D.; Peoples, Tim M.A.; Perkins, Bruce A. M.D., M.P.H.; Welsh, John B. M.D., Ph.D.; Willi, Steven M. M.D.; Wood, Michael A. M.D.; the STAR 3 Study Group 1
[Article] New England Journal of Medicine. 363(4):311-320, July 22, 2010.

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Background: Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors.

Methods: In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams. The primary end point was the change from the baseline glycated hemoglobin level.

Results: At 1 year, the baseline mean glycated hemoglobin level (8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group, as compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached the glycated hemoglobin target (<7%) was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group.

Conclusions: In both adults and children with inadequately controlled type 1 diabetes, sensor-augmented pump therapy resulted in significant improvement in glycated hemoglobin levels, as compared with injection therapy. A significantly greater proportion of both adults and children in the pump-therapy group than in the injection-therapy group reached the target glycated hemoglobin level. (ClinicalTrials.gov number, NCT00417989.)