Despite Benefits, Pump Has Drawbacks

Pumps were first used more than 20 years ago, but they were big and bulky. They’ve gotten more popular for two reasons: The pumps are slimmer and the insulin is longer-acting.

“Our biggest use of pumps has been over the last three to four years, especially on very young children,” says JoAnn Ahern, a diabetes clinical nurse specialist who is the program coordinator at Yale. Yale has prescribed the pump to about 250 patients during the last few years. The youngest was 18 months and the oldest was 60 years, says Ahern.

“The youngest kids do the best, those under 6, because their parents are totally in control,” she says. “Those age 6 to 12 do well, better than those on shots. Teens are always a challenge, but if they’re already on the pump, they do better than kids on shots, but not as well as when they were younger and their parents had more influence.”

Although the pump is an effective insulin-delivery system, “it’s not an artificial pancreas,” says Stephen G. Rosen, a Stamford, Conn., endocrinologist. “Patients still need to do a considerable amount of testing.”

Both Rosen and Ahern say the family’s support system is crucial.

“Everyone needs to understand both the positive aspects of the pump, and the problems,” says Rosen, who adds that there are about 10 patients using pumps at Stamford Hospital, all doing well. “You have to consider, ‘How compliant is the child,’ you have to explain it to the parents again and again, and consider the social situation. There are a lot of factors.”

Ahern says the parents must support each other.

“They must both agree, and help each other. It’s hard to do if you don’t have somebody supporting you,” she says.

On the other hand, “If your [child is] on shots, and nobody is supporting you, it’s the same thing.”

Ahern was the trial coordinator for a 1993 Yale study of teenagers with diabetes that revealed the benefits of the pump. “So we would give the pumps to teenagers and I just slowly moved down, down in ages. You do a teen and a 10-year-old says, ‘What about me?’ Then you do a 7, then a 6, and you finally say, ‘We’ll try it.’ When you see the results, it inspires you to offer it.’ ”