Crossing the technology divide: practical strategies for transitioning patients from multiple daily insulin injections to sensor-augmented pump therapy.

PURPOSE: To describe the benefits of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) systems compared with self-monitoring of blood glucose (SMBG) and multiple daily injection (MDI) therapy; to assess the benefits of sensor-augmented pump therapy (SAPT) in patients with type 1 diabetes; and to present an evidence-based practical protocol for introducing SAPT in patients with no prior pump or CGM experience.

CONCLUSION

Continuous glucose monitoring and CSII have advantages over SMBG and MDI, respectively, in terms of A1C and hypoglycemia reduction. The Sensor-Augmented Pump Therapy for A1C Reduction (STAR) 3 trial demonstrated that initiating both CGM and CSII in selected adult and pediatric patients with type 1 diabetes unable to meet glycemic goals with intensive insulin injection therapy significantly improved glucose control. In all subjects using SAPT, A1C levels fell rapidly from baseline to 3 months and remained significantly lower than among subjects in the SMBG+MDI group for 1 year. A distinguishing feature of the STAR 3 study was its stepwise protocol for systematizing education and self-management support using Web-based training modules and therapy management software. The demonstrated strengths of this education protocol recommend it as a model for implementing SAPT in the broader population of patients with type 1 diabetes who have not achieved their glycemic goals with optimized MDI therapy.