Benefits of continuous subcutaneous insulin infusion in type 1 diabetes previously treated with multiple daily injections with once-daily glargine and pre-meal analogues.
OBJECTIVE
There is insufficient information about the use of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) using long-acting insulin analogs in relation to possible metabolic consequences and, as well, on the grade of patient satisfaction. The aim of the study was to evaluate the usefulness of CSII treatment in patients with type 1 diabetes in achieving glycemic objectives using continuous glucose monitoring system (CGMS) and in improving patient's satisfaction with treatment.


METHODS
We have studied 45 type 1 diabetic patients treated with MDI with once-daily glargine and pre-meal rapid-acting insulin analogues, and 20 patients who commenced CSII because they had not achieved a good glycemic control.


RESULTS
With CSII, there were significant reductions in insulin requirements (0.75+/-0.21 vs. 0.64+/-0.21 UI/kg/day; p=0.001), HbA (1c) (7.99+/-0.76 vs. 7.19+/-0.51%; p=0.001) and hypoglycemic episodes (4.60+/-1.82 vs. 3.05+/-1.88 events/patient/week; p=0.031) and improved patient satisfaction with treatment. CSII reduced hyperglycemic episodes in 04:00-08 h period (131.65+/-113.49 vs. 69.70+/-101.52 min; p=0.049), 24 h period area-under-the-curve (AUC) (4521.60+/-3689.23 vs. 3000.36+/-493.96 mmol/L x min; p=0.025) and AUC before dinner (217.36+/-181.46 vs. 136.22+/-202.88 mmol/L x min; p=0.048).


CONCLUSIONS
In selected patients with poor metabolic control with once-daily glargine and pre-meal rapid-acting insulin analogues, CSII is a good alternative since it reduces hypoglycemic episodes and insulin requirement and improves glycemic control and patient's satisfaction.
Torres
I
I
Service of Endocrinology and Nutrition of the Hospital Puerta del Mar, Cádiz, Spain.
Ortego
J
J
Valencia
I
I
García-Palacios
M V
MV
Aguilar-Diosdado
M
M
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004435:Eating; D005260:Female; D006801:Humans; D007003:Hypoglycemia; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D007332:Insulin Infusion Systems; D061268:Insulin Lispro; D008297:Male; D017060:Patient Satisfaction; D018579:Patient Selection; D011788:Quality of Life; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro