The impact of continuous subcutaneous insulin infusion and multiple daily injections of insulin on glucose variability in older adults with type 2 diabetes

J Diabetes Complications. Jul-Aug 2011;25(4):211-5. doi: 10.1016/j.jdiacomp.2010.09.005. Epub 2010 Nov 9.

Abstract

Aims: To determine whether continuous subcutaneous insulin infusion (CSII) or multiple daily injections of insulin (MDI) are associated with improved glycemic variability.

Methods: Type 2 diabetic patients ≥60 years of age were randomized to 12 months of CSII (n=53) or MDI (n=54) therapy. Patients were asked to complete monthly eight-point self-monitored glucose profiles (n=78) and continuous glucose monitoring systems (CGMS) for up to 72 h at Months 0, 6, and 12 (n=77). Within-day mean glucose, standard deviation (SD), range, pre- and post-prandial glucose, M value, and mean amplitude of glycemic excursions (MAGE) were calculated from eight-point profiles. Mean glucose, SD, range, area under the curve (AUC) high (>180 mg/dl) and AUC-low (<70 mg/dl) were calculated from CGMS. Mixed model analyses of variance were used to examine the associations between treatment, time, and the study outcomes, adjusting for any effects of sex.

Results: With the use of the eight-point profiles, CSII and MDI groups did not differ with respect to mean glucose, mean pre-prandial and post-prandial glucose, SD, range, M value, or MAGE. With the CGMS data, there were no significant between-group differences in measures of mean glucose, range, SD, AUC-high, or AUC-low. In both treatment groups, all measures improved over time (P<.0001) except for AUC-low (P=.68) which did not change. There were treatment-by-time interactions when considering the CGMS range (P=.04) and AUC-high (P=.001), but no significant differences were found at individual time points.

Conclusions: Glucose variability improved equally with CSII and MDI treatment in older patients with type 2 diabetes.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Blood Glucose / analysis
  • Blood Glucose Self-Monitoring
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hyperglycemia / etiology
  • Hyperglycemia / prevention & control*
  • Hypoglycemia / etiology
  • Hypoglycemia / prevention & control*
  • Infusions, Subcutaneous
  • Injections, Subcutaneous
  • Insulin / administration & dosage*
  • Insulin / therapeutic use
  • Insulin Infusion Systems*
  • Male
  • Middle Aged
  • Monitoring, Ambulatory
  • Postprandial Period
  • Time Factors

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin
  • hemoglobin A1c protein, human