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Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12-month data from the OpT2mise randomized trial

Aronson R, Reznik Y, Conget I, Castañeda JA, Runzis S, Lee SW, Cohen O; OpT2mise Study Group

Editorial comment by Sarah Cvach

Since the DCCT trial it has been proven that sustained glycaemic control could be achieved with the use of CSII in Type 1 diabetes even better than with MDI. Diabetes complications are delayed or prevented using intensified therapy regimen. The Switch Study proofed the superiority of CSII versus MDI with significant reduction of HbA1c for adults and children. On the other hand it was unclear if the use of CSII in Type 2 diabetes would show better results than with MDI especially with overweight patients. Often they have a poor insulin sensitivity and do not reach their glycaemic goals. The OpT2mise study - published in several articles - has tried CSII regimen in patients with BMI >33, defined Insulin resistance and not reaching their goals with intensified injection therapy compared with MDI. The study proofed in a cross over design the superiority of CSII versus MDI. The results showed a reduction in HbA1c by 1.1 % in the CSII group and 0.4 % in the MDI group after 6 months which was significant. Insulin dose was 20.4 % lower with pump therapy than with MDI, no difference in weight gain was seen in both groups, no event of Ketoacidosis and no difference in severe hypoglycaemia. The HbA1c reduction of the pump group was maintained over 12 months and therefore showed a sustained and durable effect of insulin pump therapy in overweight Type 2 diabetes patients with defined insulin resistance not achieving their targets. It could be concluded that CSII was a good alternative in Type 2 diabetes especially for patients with high BMI, showing signs of insulin resistance, because CSII regimen leads to a 20.4 % reduction of the daily insulin dose and might therefore not enhance the body weight significantly.