title: The Impact of Continuous Subcutaneous Insulin Infusion Therapy on Efficacy and Safety in a Cohort of Type 1 Diabetes Patients: A 3-Year Prospective Study.
abstract: BACKGROUND
  Several studies have found improved glycemic control with continuous subcutaneous insulin infusion compared with multiple daily insulin injections for patients with type 1 diabetes, albeit for a relatively short-period of follow-up. This prospective study presents for the first time the optimization of glycemic control with insulin pumps in a cohort of Greek patients with type 1 diabetes for a 3-year follow-up period during the socioeconomic crisis in Greece.
  
  
  METHODS
  Ninety-four patients, previously on intensified basal-bolus insulin therapy with poor glycemic control, were initially recruited. Glycosylated hemoglobin (HbA1c), hypoglycemic and diabetic ketoacidosis episodes, pump-related side effects, lipidemic profile, 24-h urine albumin excretion, body mass index, blood pressure, and total daily insulin requirements (bolus and basal) were recorded during the 3-year follow-up. Statistical analysis was initially conducted for the entire study population and after body mass index and gender stratification.
  
  
  RESULTS
  Seventy-nine patients completed the study. A statistically significant decrease of HbA1c level (P < 0.0001) was observed at the end of Year 1 and was retained for the following years for the whole population. Similarly, significantly fewer hypoglycemic episodes occurred during the follow-up period (P < 0.0001) compared with study entry. Insulin pump treatment was not accompanied with weight changes across all body mass index strata.
  
  
  CONCLUSIONS
  Continuous subcutaneous insulin infusion achieved almost optimal glycemic control, reduced the number of hypoglycemic episodes without weight gain, and was well tolerated for the whole study period. Finally, this therapeutic approach was accompanied with lower daily insulin requirements.
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Andreas
authors: A
authors: Melidonis
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Alexandros
authors: A
authors: Kamaratos
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Angeliki
authors: A
authors: Angelidi
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Petros
authors: P
authors: Thomakos
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Spiridon
authors: S
authors: Vrakas
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: John
authors: J
authors: Bakalis
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Evangelos
authors: E
authors: Fousteris
authors: Diabetes Center, Tzanio General Hospital of Piraeus , Piraeus, Greece .
authors: Stella
authors: S
authors: Iraklianou
mesh_terms: D000328:Adult; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006115:Greece / Q000453:epidemiology; D006786:Hospitals, Urban; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D061267:Insulin Aspart / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D061268:Insulin Lispro / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart; D061268:Insulin Lispro; C517652:hemoglobin A1c protein, human; C479079:insulin glulisine