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Type 2 diabetes is a progressive disease of insulin resistance and B-cell failure (cells that store and produce insulin) resulting in a continued and progressive need to intensify diabetes therapies to maintain glycemic (blood sugar) control. Eventually most people with type 2 diabetes require insulin replacement therapy. This is generally initiated with basal (background) insulin and, if needed, bolus (mealtime) insulin is introduced to address the high blood sugar after a meal.1 This "basal-bolus" insulin therapy is most frequently administered by multiple daily injections (MDI) with an insulin syringe or pen device. Unfortunately MDI therapy can be challenging and patient compliance and persistence with MDI therapy is frequently inadequate.2 Potential barriers to MDI, which can result in suboptimal glycemic control, include; having to take multiple injections, interference of injections with daily activities, injection pain and embarrassement.2 As a result many people using MDI therapy do not achieve target glycemic control.3

Continuous subcutaneous insulin infusion (CSII) therapy using an insulin pumps addresses many of the barriers associated with MDI therapy and could result in enhanced adherence. In type 1 diabetes, CSII therapy has shown benefits over MDI therapy including improved glycemic control, reduced glycemic variability, higher quality of life and has become standard of care.4,5,6 Several studies have assessed CSII therapy in type 2 diabetes; consistent with type 1 diabetes, these studies have shown improved glycemic control and improved quality of life compared to their baseline values at initiation of CSII therapy.7-12 Despite these positive findings, CSII has not been widely used in T2DM. The extensive training required to use these pumps and the up-front cost of over $7,500 can be a formidable barrier to patients with type 2 diabetes.13 Current insulin pumps can be programmed to deliver up to 48 different basal infusion rates per day in increments as small as 0.025 units. Although having multiple basal rates and the ability to deliver very precise increments is important for many patients with type 1 diabetes, data from recently published studies have found patients’ with type 2 diabetes are able to achieve good glycemic control with one or two daily basal rates.12,14

New simple to use insulin infusion devices, such as PAQ, have been developed to provide the benefits of CSII therapy without the complexity and up front expense. In addition, PAQ has been designed to reduce the barriers and challenges of daily insulin injection therapy to enable people to achieve target glycemic control. Click to see clinical performance.

References

1. DeFronzo, RA: From the triumvirate to the ominous cotet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes 2009;58:773–795.

2. Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care. 2010;33:240–245.

3. Cheung BM, Ong, KL, Cherny SS, Sham PC, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med. 2009;122:443–453.

4. Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injection therapy in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ. 2002;324:705–708.

5. Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med. 2008;25:765–774.

6. Jeitler K, Horvath K, Berghold A, Gratzer TW, Neeser K, Pieber TR, et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia. 2008;51:941–951.

7. Raskin P, Bode BW, Marks JB, Hirsch IB, Weinstein RL, McGill JB, et al. Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally effective in type 2 diabetes: a randomized, parallel-group, 24-week study. Diabetes Care. 2003;26:2598–2603.

8. Herman WH, Ilag LL, Johnson SL, Martin CL, Sinding J, Al Harthi A, et al. A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes. Diabetes Care. 2005;28:1568–1573.

9. Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, et al. Insulin pump therapy vs. multiple daily injections in obese type 2 diabetic patients. Diabet Med. 2005;22:1037–1046.

10. Berthe E, Lireux B, Coffin C, Goulet-Salmon B, Houlbert D, Boutreux S, et al. Effectiveness of intensive insulin therapy by multiple daily injections and continuous subcutaneous infusion: a comparison study in type 2 diabetes with conventional insulin regimen failure. Horm Metab Res. 2007;39:224–229.

11. Parkner T, Laursen T, Vestergaard ET, Hartvig H, Smedegaard JS, Lauritzen T, et al. Insulin and glucose profiles during continuous subcutaneous insulin infusion compared with injection of a long-acting insulin in Type 2 diabetes. Diabet Med. 2008;25:585–591.

12. Edelman SV, Bode BW, Bailey TS, Kipnes MS, Brunelle R, Chen X, et al. Insulin pump therapy in patients with type 2 diabetes safely improved glycemic control using a simple insulin dosing regimen. Diabetes Technol Ther. 2010;12:627–633.

13. Skyler JS, Ponder S, Kruger DF, et al. Is there a place for insulin pump therapy in your practice. Clin Diabetes. 2007;24:50–56.

14. King, A, Clark, D, Wolfe, G. The number of basal rates required to achieve near-normal glucose control in pump-treated type 2 diabetes. Diabetes Technology & Therapeutics. 2012;14(10).