Role of continuous subcutaneous insulin infusion in patients with recalcitrant diabetes in South India.
BACKGROUND
We aimed to assess the effect of continuous subcutaneous insulin infusion (CSII) therapy in patients with "recalcitrant diabetes" whose glycemia had not been controlled adequately with multiple daily injections of insulin or insulin plus oral hypoglycemic agents.


METHODS
We retrospectively analyzed the medical records of patients with diabetes who were initiated on insulin pump therapy at our center in India between 2002 and 2007. Data analysis included fasting and postprandial blood glucose and glycated hemoglobin (HbA1c) values, insulin requirement, body weight, and the occurrence of hypoglycemia and diabetic ketoacidosis.


RESULTS
We studied 33 patients with diabetes (type 1 [n = 17] and type 2 [n = 16]) who were on CSII therapy for a mean duration of 3.4 years. A statistically significant reduction in HbA1c was found after initiating CSII (prepump 10.7% vs. postpump 8.3%, P < 0.001). The reduction was greater in type 1 patients (10.6 +/- 2.1 vs. 8.0 +/- 1.6%) than in type 2 patients (11.0 +/- 2.1 vs. 8.8 +/- 1.4%). There was a reduction in frequency of severe hypoglycemia after starting the CSII pump, and there were no instances of diabetic ketoacidosis.


CONCLUSIONS
Although HbA1c levels did not reach optimal targets, our data indicate that CSII is an effective therapy for patients with diabetes having recalcitrant diabetes who can afford this treatment and whose glycemia is poorly controlled with conventional therapies.
Sudhakaran
Chidambarann
C
Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control, Chennai, India.
Anjana
Ranjit Mohan
RM
Rao
Kavitha
K
Unnikrishnan
Ranjit
R
Suresh
Thangamani
T
Mohan
Viswanathan
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007194:India; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008499:Medical Records; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin