Adults, type 1 diabetes: high HbA1c predicted benefit from pump therapy.

Insulin Pump with sensor

The STAR trial investigated the benefits of sensor-augmented pump therapy compared with multiple daily injections (MDI) in adults with type 1 diabetes.

This report of results from the trial tries to identify features of the patients who were more likely to experience improved glycaemic control in both group.  This might help us to identify patients who are likely to benefit from pump therapy.

The researchers looked for a reduction in HbA1c of more than 0.5% without severe hypoglycemia.

In both groups – pump therapy and MDI –  Higher baseline HbA1c predicted a greater reduction in HbA1c in both groups, more so in the pump therapy group than the MDI group.

For pump therapy, age was also associated with improvement in HbA1c.

Appraisal hints

Readers of this paper are advised to consider:

  • This is not the final report of the STAR trial results, which directly compared pump therapy with multiple daily injections.
  • It’s not clear whether this analysis was part of the original study protocol, or whether this is data they decided to look at after the fact.  This might affect our confidence in the data;  they may have occured by chance.
  • Note that the associations drawn here may not necessarily imply a causal link.
  • The impact of co-interventions provided alongside pump therapy should be considered.
  • Applicability of the findings to your own patient or population.
  • This individual study needs to be seen in the context of guidelines and systematic review evidence around this new technology.


The full text of this paper is available as open access for free.

Buse JM, Dailey G et al.  Baseline Predictors of A1C Reduction in Adults Using Sensor-Augmented Pump Therapy or Multiple Daily Injection Therapy: The STAR 3 Experience.  Diabetes Technology & Ther 2011;13(6): 601-6



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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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