Opportunities to overcome underutilization of enhanced insulin delivery technologies in people with type 2 diabetes: a narrative review

Figures & data

Table 1. Recent studies of on body insulin delivery device and tubeless insulin pump therapy in T2D.

Patch Pump System (Author & Publication Year)	Study Design (Type, Duration, Comparison Groups)	Study Population (n, Mean Baseline Demographics)	Outcome Measures	Results
V-Go Lajara 2015 [57]	Retrospective 27 weeks T2D Switched to Tubeless pump from MDI	n = 204 HbA1c 9.63% TDD 78 ± 46	HbA1c TDD	−1.53% HbA1c change at 14 weeks, p < 0.001 −1.79% HbA1c change at 27 weeks, p < 0.001 −28 U to −41 U TDD change at 27 weeks
V-Go Lajara 2016 [59]	Retrospective (medical records) 27 weeks T2D Tubeless pump vs. MDI	n = 116 HbA1c: 10.51%	HbA1c TDD Cost (PPPM, PPPQ)	Greater HbA1c reduction: V-Go vs. MDI: -1.98% vs −1.34%, p = 020 Less TDD: V-Go vs. MDI: 56 ± 17 U vs 78 ± 40 U, p<0.001 Lower diabetes-related direct pharmacy costs and cost inferential per 1% HbA1c reduction: V-Go vs. MDI $118.84±$158.55 PPPM vs $217.16±$251.66 PPPM
V-Go Sutton 2016 [66]	Retrospective 14 months T2D Switched to Tubeless pump from MDI	n=103 HbA1c 8.6%	HbA1c TDD Cost (PPPM)	−1.67% HbA1c change, p<0.001 −30 U TDD change, p<0.001 Direct pharmacy wholesale acquisition costs for diabetes therapeutics reduced by $25.00/PwD/month
V-Go Wahlqvist 2018 [69]	Simulation model analysis T1D V-Go vs. MDI Over 40 years	n= 331 HbA1c 8.0% to 12.0%	QALY Life-time, per-PwD costs	0.17 QALYs gained per PwD compared with MDI $66,883 lifetime cost-savings
V-Go Cziraky 2019 [70]	Prospective pragmatic clinical trial T2D V-Go vs. Standard Care (SC) Up to 4 months	n=415 HbA1c 9.6%	HbA1c Cost of therapy	V-Go: −1.0%, p<.001 SC: −0.5%, p<.001 V-Go had significantly larger decrease (p=.002) Cost per day: V-Go vs. SC ($30.59 vs. $32.20 Cost effectiveness per 1.0% HbA1c: V-Go vs. SC ($24.02 vs. $58.86)
V-Go Grunberger 2020 [61]	Prospective, open-label, multicenter 12 months T2D Switched to Tubeless pump from: OADs; OADs+non-insulin injectable; Premix insulins injections± OADs/non-insulin injectable; or MDI	n=112 HbA1c 8.88%	HbA1c Hypoglycemia Tx Satisfaction	−0.64% HbA1c change, p=0.003 22 PwD reported a hypoglycemic event (≤70 mg/dL); hypoglycemic event rate: 1.51 events/year Treatment satisfaction (1=low, 10=high): Comfort − 7.9 Discreet − 8.4 Physical Well-being − 7.8 Mental Well-being − 8.1 Ease of use compared to previous therapy − 8.7
CeQur Mader 2018 [64]	Prospective, open-label, non-controlled 12 weeks T2D Switched to Tubeless pump from MDI (bolus dosing)	n=28 HbA1c 8.6%	HbA1c Hypoglycemia (≤70 mg/dL) Tx Satisfaction (DTSQ)	−1.4% HbA1c change, p<0.0001 Hypoglycemia rate (episodes per 30 days) increased from 1.1 to 2.1 DTSQ total score increased from 29.18 to 33.30, p=0.0051
CeQur Isaacs 2022 [68]	Online Survey T1D, T2D Switched to Tubeless pump from: Syringe; Pen; Pump; or Inhaler	N=106 (T1D, n=27; T2D, n=74; Not sure, n=2; Other, n=3)	Satisfaction (Insulin Delivery System Rating Questionnaire [IDSRQ])	Significant improvements in all IDSRQ subscales: Insulin delivery method satisfaction: 1.32, p<0.05 Interference with activities: −0.71, p<0.05 Clinical outcomes: 1.38, p<0.05 Diabetes-related worry: −0.91, p<0.05 Psychological well-being: 0.60, p<0.05
Omnipod Layne 2018 [65]	Multicenter, retrospective 3 months Switched to Tubeless pump from MDI	n=81 HbA1c 9.1±1.5% TDD 100.2 U	HbA1c TDD Hypoglycemia	−1.2% HbA1c change, p<0.001 −27.6 U TDD change. p=0.001 −42.2% change in weekly hypoglycemic events
Omnipod Carlson 2021 [71]	Retrospective, observational 3 months T2D Switched to Tubeless pump from: MDI; or Conventional Insulin Pump	n=3,592 HbA1c 9.2±2.0% TDD 104±71U	HbA1c TDD Hypoglycemia (<70 mg/dL) PRO (n=2,028)	−1.3% HbA1c change −33±52 U TDD change Reductions in Hypoglycemic Events: from 1.2±2.0 to 0.7±1.1, p<0.0001 PRO – Reasons for switching to Tubeless device: Prior MDI users (n=1,516): ‘Better glycemic control’ − 25% ‘Did not want to be tethered to tubing’ − 24% ‘Replace discomfort and hassle of injecting’ − 16% ‘Replace MDI and provide greater flexibility in eating/exercise’ − 12% Prior Convention Pump users (n=349): ‘Did not want to be tethered to tubing’ − 32% ‘Ability to wear it in various places’ − 16% ‘Wanted a waterproof pump’ − 12%

DTSQ=Diabetes Treatment Satisfaction Questionnaire; IDSQR=Delivery System Rating Questionnaire; OADs=oral antihyperglycemic drugs; PPPM=per patient per month; PPPQ=per patient per quarter; PRO=person-reported outcomes; TDD=total daily insulin doses.

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