Experiences with Insulin Pump in 52 Patients with Type 2 Diabetes in India
Abstract Number: 2021-PO
Authors: JOTHYDEV KESAVADEV, ANUPAM KUMAR, SHEBEER AHAMMED, SUNITHA JOTHYDEV, Trivandrum, Kerala, India
Institutions: Trivandrum, Kerala, India
Results: Insulin pump is a time-tested therapeutic option for diabetes. Pumps are being used largely in patients with type 1 diabetes. Type 2 diabetes culminates in near total beta cell exhaustion and with increased longevity in patients with diabetes, insulin will be required at some stage or the other. Strict criterion for selection of an appropriate patient is essential.
Our study considered patients with T2DM on insulin as potential candidates, if they fulfilled our criteria.Pumps are not covered by insurance in India and only affordable patients are included. Pump deployment is carried out as an outpatient procedure, with a full day stay, for educating patient and family. Follow up is through Diabetes Tele-management System (DTMS) and hospital visits. Patients report self monitored blood glucose values through telephone or internet, precluding the necessity for visits. Dose modifications are done by diabetologist. Patients were put on concomitant oral agents since in our experience, those on combination therapy with insulin and oral agents, when switched to pump, required a higher insulin dose. 22 patients had a post-breakfast blood glucose hike and required acarbose.
An inclusion criteria that comprises affordability for pump and consumables, family support, self learning skills and motivation levels is essential when choosing an appropriate patient. Among the affordable, weight gain due to over eating and correction boluses was the major concern.
Subjects made unique adaptations that suited ethnic dressing, to wear pump. Men either clipped it to the “mundu” or made holes in undergarments, to bring out the infusion tube. A few hung pump around neck. One patient designed an indigenous waist belt cum pump pouch. Females who wore saree and churidhar integrated it to undergarments.
Reasons for discontinuation of pump
We recommend insulin pumps in type 2 diabetes in highly selective patients, as it is a cost-effective option whose expenses are largely offset by long term clinical benefits. A collective effort involving teamwork, time, training and tele follow up is imperative in minimizing the defaulter rate.[figure1]