Improved glycemic control with use of continuous subcutaneous insulin infusion compared with multiple insulin injection therapy

Endocr Pract. Sep-Oct 2000;6(5):357-60. doi: 10.4158/EP.6.5.357.

Abstract

Objective: To compare, in a long-term study, glycemic control by means of continuous subcutaneous insulin infusion (CSII or insulin pump therapy) versus multiple insulin injection therapy (MIIT) in routine clinical practice.

Methods: We identified, from a search of medical records, all active patients (N = 90) receiving CSII who had previously received MIIT. The primary objective was to compare the mean glycemic control, as documented by frequent measurements of glycosylated hemoglobin (HbA(1c)), during the 3-year period before initiation of CSII versus the mean glycemic control during the 3-year period after the first year of CSII. We included all patients for whom we had sufficient data for at least 1 year for both the pre- and post-CSII periods and only those patients who had received MIIT before CSII (N = 58). To eliminate potential biases, we excluded HbA(1c) values for the first year after initiation of CSII therapy.

Results: For the entire study group, the mean HbA(1c) +/- standard error for the 3-year period before insulin pump therapy (during MIIT) was 8.4 +/- 0.2% versus a mean HbA(1c) of 7.7 +/- 0.1% for the 3-year period after the first year of CSII. This 0.7% improvement in HbA(1c) was statistically significant (P = 0.001). Of the 34 patients with HbA(1c) values above 8.0% during MIIT, the mean HbA(1c) decreased from 9.2 +/- 0.2% with use of MIIT to 8.2 +/- 0.2% with CSII (P = 0.0006). In the 17 patients with HbA(1c) values above 9.0% during MIIT, the mean HbA(1c) declined from 10.0 +/- 0.3% with use of MIIT to 8.4 +/- 0.3% with CSII (P = 0.0006).

Conclusion: We conclude that implementation of intensive insulin therapy with CSII improves glycemic control, even in patients in whom MIIT has previously been used to its maximal effect.

Publication types

  • Comparative Study

MeSH terms

  • Blood Glucose / metabolism*
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use*
  • Injections, Subcutaneous
  • Insulin / administration & dosage
  • Insulin / therapeutic use*
  • Insulin Infusion Systems*
  • Patient Compliance
  • Retrospective Studies
  • Risk Factors

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin