Teens and Insulin Pumps – Isn’t the challenge really diabetes?
I’m struggling with the media hype coming out of the American Academy of Pediatrics Journal‘s recently published article about the dangers of insulin pumps usage in adolescents. According to FDA records there were 1594 injuries to teens related to pump usage during a ten year period and thirteen teens died using insulin pumps in that decade. These are scary numbers and they are reportedly higher in teens than in younger and older age groups using the pump. However, the study did not have a control group of teens on multiple daily injections. I question if the pump is dangerous or if the challenge of diabetes is especially trying during the adolescent years.
The study conducted in the FDA’s Manufacturer and User Facility Device Experience Database looks at problems reported with insulin pump use and analgesic pump use (pumps providing pain meds). The database does not contain information about multiple daily injections. I was left wondering how many diabetic teens experienced DKA, complications or died during the ten year period as a result of non compliance or error with insulin injections. Two apparently committed suicide with pumps. How many diabetic teens committed suicide with injections? In my opinion suicide with an insulin pump is a mental health issue not a medical device failure.
The conclusion I draw from the study is that managing diabetes as a teenager is extremely difficult. Hormonal changes, peer pressure, the challenges of balancing competitive sports and insulin usage present daily challenges to teens. The pump failures appeared to occur most often when teens lacked supervision or education about the pump . Pumps only work as well as they are managed; just as injections only work when they are given with good insulin.
Insulin delivery decisions are made with blood glucose data and blood glucose is taken with glucometers (blood sugar meters) or continuous glucose monitors. There was no discussion on how good the blood sugar data was. Frequent blood glucose testing is the most important act to assure insulin is delivered safely. See Dave Mendosa's post about accuracy issues of glucometers ("What's My Blood Glucose Level").
Ginger wrote a good blog on the DiabeTeens site warning about the importance of using pumps carefully ("Pumping Aint' Perfect!"). I hope the FDA report doesn’t dissuade anyone from using a pump. I hope it just encourages users and their family to take care in how they use the pump.
Ultimately, I’d like to see a study compare compliance and complications of pump users and MDI patients. And I’d like to see how parental involvement relates to good outcomes.