title: Glargine basal-bolus insulin regimen versus insulin pump therapy: comparison of glycemic control.
abstract: BACKGROUND
  Study results have varied when blood sugar control for subjects using a glargine basal-bolus insulin regimens (GBBIR) have been compared with those using continuous subcutaneous insulin infusion (CSII). Of 12 studies comparing GBBIR with CSII, six found improved glycemic control with CSII and six found no significant difference. These studies were often limited by small numbers of subjects and other study design parameters.
  
  
  METHODS
  We reviewed hemoglobin (Hb) A1c data for youths with type 1 diabetes (n=43) changing from conventional split mix insulin regimens (CSMIR) to GBBIR and subsequently to CSII at 3, 6 and 12 months after each transition. All subjects had a diabetes duration of at least 1 year before initiating GBBIR.
  
  
  RESULTS
  HbAlc levels at 3 months, 6 months and 1 year were not significantly different for GBBIR and CSII regimens. HbAlc increased significantly during GBBIR (p=0.036) and marginally during CSII (p=0.058) when 3-month and 1-year values were compared.
  
  
  CONCLUSIONS
  We found no significant difference in glycemic control, as reflected by HbAlc, in youths with type 1 diabetes treated with GBBIR and CSII for up to 1 year. Blood sugar control waned by 12 months in both the GBBIR (p=0.036) and CSII (p=0.058) groups, which suggests that "burn out" qually affects those on each regimen. Additional investigation of glycemic variability and quality of life for those on GBBIR and CSII would be clinically relevant.
authors.affiliation: BD Diabetes Center for Children and Adolescents, Goryeb Children's Hospital, Morristown, NJ 07962, USA. harold.starkman@atlantichealth.org
authors.forename: Harold
authors.initials: H
authors.lastname: Starkman
authors.forename: Emily
authors.initials: E
authors.lastname: Frydman
authors.forename: Rami
authors.initials: R
authors.lastname: Bustami
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D007332:Insulin Infusion Systems; D049528:Insulin, Long-Acting; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human