Assessment of therapy with continuous subcutaneous insulin infusion in an academic diabetes clinic.
OBJECTIVE
To assess the results of continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus, especially relative to glycemic control and rate of discontinuation of insulin pump therapy.


METHODS
A retrospective review of the medical records of 107 patients with type 1 diabetes who were receiving CSII at the Diabetes Care Center at the University of Washington Medical Center was performed to evaluate clinical outcomes. All patients considering CSII therapy participated in a class to learn the details of insulin pump treatment.


RESULTS
The mean age of our patient population was 36.0 +/- 10.4 years (mean value +/- standard deviation). The mean duration of diabetes at the initiation of insulin pump therapy was 17.0 +/- 9.1 years. The mean duration of CSII use was 36.1 +/- 25.5 months (median, 26.2 months). Insulin lispro was used by 89.7% of the patients. Six patients (5.6%) discontinued CSII therapy after a mean of 19.1 +/- 14.7 months for a variety of reasons. Despite no significant difference in home blood glucose monitoring (number of tests per day) before initiation of CSII, mean hemoglobin A1c levels decreased from 7.6% to 7.1% (P<0.0001), and the occurrence of severe hypoglycemic episodes decreased 73.8% (P = 0.0003).


CONCLUSIONS
In our academic diabetes clinic with a formal insulin pump program, we noted a significant improvement in hemoglobin A1c values, a significant reduction in the frequency of severe hypoglycemic episodes, and a low rate of discontinuation of CSII. CSII therapy, when provided in conjunction with a standard educational program, should continue to be an important treatment option in appropriately selected patients with type 1 diabetes.
Rudolph
Justen W
JW
Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle, Washington, USA.
Hirsch
Irl B
IB
D000328:Adult; D003863:Depression / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data; D008297:Male; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D012189:Retrospective Studies
D006442:Glycated Hemoglobin