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Aims  To compare insulin pump therapy and multiple daily injections ( MDI ) in patients with type 2 diabetes receiving basal and prandial insulin analogues.    Methods  After a 2‐month dose‐optimization period, 331 patients with glycated haemoglobin ( HbA1c ) levels ≥8.0% and ≤12% were randomized to pump therapy or continued  MDI  for 6 months [randomization phase ( RP )]. The  MDI  group was subsequently switched to pump therapy during a 6‐month continuation phase ( CP ). The primary endpoint was the between‐group difference in change in mean  HbA1c  from baseline to the end of the  RP .    Results  The mean  HbA1c  at baseline was 9% in both groups. At the end of the  RP , the reduction in  HbA1c  was significantly greater with pump therapy than with  MDI  (−1.1 ± 1.2% vs −0.4 ± 1.1%; p < 0.001). The pump therapy group maintained this improvement to 12 months while the  MDI  group, which was switched to pump therapy, showed a 0.8% reduction: the final  HbA1c  level was identical in both arms. In the  RP , total daily insulin dose ( TDD ) was 20.4% lower with pump therapy than with  MDI  and remained stable in the  CP . The  MDI –pump group showed a 19% decline in  TDD , such that by 12 months  TDD  was equivalent in both groups. There were no differences in weight gain or ketoacidosis between groups. In the  CP , one patient in each group experienced severe hypoglycaemia.    Conclusions  Pump therapy has a sustained durable effect on glycaemic control in uncontrolled type 2 diabetes.

diabetes, obesity and metabolism

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