Continuous Insulin Infusion in Diabetes Management

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The desirability of close glucose control, highlighted by the Diabetes Control and Complications Trial (DCCT), led many diabetics to undertake multiple daily injections (MDI) to improve their diabetes management. But for some, this meant a heightened risk of hypoglycemic episodes. Insulin pumps had been available for some time and they now offered a possible means of achieving heightened glucose control without such a high risk of hypoglycemia through Continuous Subcutaneous Insulin Infusion (CSII).

In fact, Bode and Steed (Bode BW & Steed RD [1996], Reduction in Severe Hypoglycemia with Long-term CSII in Type I Diabetes. Diabetes Care 1996: 324–327) studied patients who had been using MDI and who had experienced recurrent hypoglycemia, and hypoglycemic unawareness. These patients transferred to CSII. The incidence of severe hypoglycemia declined more than six-fold during the first year of CSII, and remained significantly lower in years two, three and four on CSII. The frequency of diabetic ketoacidosis also declined with CSII from 14.6% to 7.2%. The average daily insulin dose one year after initiation was 15% lower than the MDI dosage. In this study, “patients maintained an excellent level of glycemic control, and achieved a significant reduction in the rate of severe hypoglycemia relative to pre-study management with MDI.” CSII therefore becomes the prime mechanism when there is a clear failure of MDI.

Due to innovation and increased acceptance, the global market for insulin pump and related disposables is growing in the double-digits, led by such companies as Roche Insulin Delivery Systems (formerly Disetronic) and Medtronic’s MiniMed, which together hold the lion’s share of the market. A range of innovations continues to emerge from these manufacturers and others to improve the ease of use, the level of glucose control and the overall quality of life for diabetics.

[Shown is Insulet’s OmniPod®, which is a tubeless pump via its direct contact to the patient’s skin, with infusion provided through a subcutaneous cannula.]

Diabetes technologies worldwide are the subject of the MedMarket Diligence report #D510, “Diabetes Management: Products, Technologies, Markets and Opportunities Worldwide 2009-2018.”

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I serve the interests of medical technology company decision-makers, venture-capitalists, and others with interests in medtech producing worldwide analyses of medical technology markets for my audience of mostly medical technology companies (but also rapidly growing audience of biotech, VC, and other healthcare decision-makers). I have a small staff and go to my industry insiders (or find new ones as needed) to produce detailed, reality-grounded analyses of current and potential markets and opportunities. I am principally interested in those core clinical applications served by medical devices, which are expanding to include biomaterials, drug-device hybrids and other non-device technologies either competing head-on with devices or being integrated with devices in product development. The effort and pain of making every analysis global in scope is rewarded by my audience's loyalty, since in the vast majority of cases they too have global scope in their businesses. Specialties: Business analysis through syndicated reports, and select custom engagements, on medical technology applications and markets in general/abdominal/thoracic surgery, interventional cardiology, cardiothoracic surgery, patient monitoring/management, wound management, cell therapy, tissue engineering, gene therapy, nanotechnology, and others.
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