title: Long-term metabolic effects of continuous subcutaneous insulin infusion therapy in type 1 diabetes.
abstract: BACKGROUND
  Continuous subcutaneous insulin infusion (CSII) and intensive multiple daily insulin injections (iMDI) program are treatment options in patients with type 1 diabetes not achieving optimal glycemic control. The long-term effects of CSII in patients with type 1 diabetes in comparison with those educated for iMDI are poorly documented.
  
  
  METHODS
  Medical records for patients commenced on CSII or undertaking an iMDI program between 2000 and 2011 were extracted. Change in hemoglobin A1c (HbA1c), hypoglycemia, and weight were analyzed. Prior to CSII or iMDI commencement, all patients were on basal bolus analog insulin. Data from blood glucose meter downloads before and 6 months after CSII and iMDI were also analyzed.
  
  
  RESULTS
  One hundred twenty-six CSII and 121 iMDI patients were studied, with mean (±SD) follow-up of 39±26 and 48±26 months, respectively. For CSII, HbA1c was significantly lower than baseline at every time period up to 36 months. Peak HbA1c reduction was 0.64% at 6 months, following which the HbA1c change declined. For iMDI, HbA1c was significantly reduced only at 6 months, by 0.15%. Glucose meter data were available for 119 patients. CSII-treated patients had a significant decrease in mean glucose and glucose SD with no change hypoglycemia at 6 months compared with baseline; no differences were observed for iMDI-treated patients.
  
  
  CONCLUSIONS
  CSII in type 1 diabetes is associated with improved glycemic control with no increase in hypoglycemia. HbA1c improvement declined over time, suggesting a need for re-education after CSII commencement. The iMDI program did not have significant glycemic benefits.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia. neale.cohen@bakeridi.edu.au
authors.forename: Neale D
authors.initials: ND
authors.lastname: Cohen
authors.forename: Eui S
authors.initials: ES
authors.lastname: Hong
authors.forename: Christy
authors.initials: C
authors.lastname: Van Drie
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shaw
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D014739:Victoria
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human