Treatment of Diabetes — To Pump or Not to Pump

This clinical decision article explores the management of a 31-year-old woman with type 1 diabetes and impaired hypoglycemia awareness, presenting after a severe hypoglycemic episode. Two treatment options are debated: (1) pairing a real time continuous glucose monitor (rt-CGM) with an insulin pump for automated feedback control, or (2) using rt-CGM with alerts alone. Advocates for the pump emphasize its superior glycemic control and reduced hypoglycemia risk (supported by DCCT-EDIC trials), while proponents of rt CGM alone highlight its cost-effectiveness, ease of use, and proven reduction in hypoglycemia (per the IN CONTROL trial). The discussion underscores the need to balance safety, lifestyle impact, and patient preference in diabetes technology adoption.

This clinical decision article explores the management of a 31-year-old woman with type 1 diabetes and impaired hypoglycemia awareness, presenting after a severe hypoglycemic episode. Two treatment options are debated: (1) pairing a real time continuous glucose monitor (rt-CGM) with an insulin pump for automated feedback control, or (2) using rt-CGM with alerts alone. Advocates for the pump emphasize its superior glycemic control and reduced hypoglycemia risk (supported by DCCT-EDIC trials), while proponents of rt CGM alone highlight its cost-effectiveness, ease of use, and proven reduction in hypoglycemia (per the IN CONTROL trial). The discussion underscores the need to balance safety, lifestyle impact, and patient preference in diabetes technology adoption.