AT THE ADA ANNUAL SCIENTIFIC SESSIONS
NEW ORLEANS (FRONTLINE MEDICAL NEWS) – Insulin pump therapy may be feasible and beneficial for select low-vision diabetes patients, results from a case report demonstrated.
“A significant complication of poorly controlled diabetes is visual impairment,” Anna Simos, MPH, said at the annual scientific sessions of the American Diabetes Association. “Insulin dosing and diabetes self-management are challenging for visually impaired patients. Despite the known benefits of insulin pumps, the use is low in patients with visual impairment due to inherent limitations. As a result, there is little published data about insulin pump therapy in visually impaired patients.”
Ms. Simos, a certified diabetes educator at Stanford (Calif.) Health Care, discussed the case of a 49-year-old legally blind patient with type 1 diabetes since who presented to Stanford’s endocrine clinic in early 2015, complaining of increasingly poor glycemic control. He lives with his wife and son, works full time from home, and provides his own self-care with occasional help from family members. Ms. Simos described his medication regimen as “complex due to the diabetes and related comborbidities.” The man’s medical history includes coronary artery disease, obesity, hypertension, hyperlipidemia, and Gaucher disease. His diabetes-related complications include retinopathy, end-stage renal disease, neuropathy, osteomyelitis, and gastroparesis.
Upon presentation at the endocrine clinic the patient’s hemoglobin A1c was 9.8%, his diabetes-related comorbidities were rapidly advancing, and there was a loss of integrity at his injection sites. “There was also a concern about incomplete insulin delivery,” Ms. Simos said. “In addition, there were challenges with his glucose meter and his record keeping. After analysis of all the barriers, we decided to transition the patient to insulin pump therapy.”
The patient reviewed all available existing pumps and selected the OmniPod Insulin Management System , a small, adhesive, tubeless insulin patch pump that features an automated cannula insertion. The device is paired with a wireless, handheld personal diabetes manager controller that programs the pod. The controller “is responsible for the insulin delivery instructions and controls the insulin delivery,” she explained. “It also contains an integrated blood glucose meter.”
After a series of training sessions, the patient began using the patch pump in April of 2015. At the same time, he used a smart phone app called the KNFB Reader for iOS, which translates the controller’s personal diabetes manager screen text and written instructions into speech. “Smartphone reminders were integrated with his basic pump functions as a safety mechanism and his caregiver support team was trained to confirm that the pod was placed correctly,” Ms. Simos said.
After the patient used the device for 6 months, the treatment team noticed a significant decrease in his total daily dose of insulin. “His insulin to carb rate decreased, his glucose correction factor decreased, and his target blood glucoses decreased,” she said. “In addition, we noticed increased compliance of his monitoring.”
Patch pump use was associated with a total daily insulin dose (TDD) of 70-75 units, compared with a TDD of 110-112 units he experienced while using a metered dose inhaler (MDI), a reduction of nearly 40%. Average A1c levels also fell to 6.9% after use of the patch pump, down from the 9.8% he experienced while using a MDI.
According to Ms. Simos, factors to consider when initializing insulin pump therapy with a visually impaired patient include motivation to collaborate, willingness to dedicate time to train on a device, and having a committed support team at home. “We found it beneficial to perform a site visit at the patient’s home and alleviate any potential risks in his environment,” she said.
She reported having no financial disclosures.