ABSTRACT. Objective. The aim of this study was to evaluate the metabolic effects of continuous subcutaneous insulin infusion (CSII) with flexible multiple daily insulin (FMDI; premeal lispro ؉ bedtime glargine) therapy as determined by glycosylated hemoglobin (HbA 1c ), body mass index (BMI), and hypoglycemic episodes in a group of patients who made the transition from multiple daily insulin (premeal lispro ؉ bid ultralente) to either CSII or FMDI therapy.Methods. Data from 40 (27 female and 13 male) patients (10.1-17.8 years of age) who were on CSII and 40 age-and gender-matched (27 female and 13 male) patients (10.3-17.3 years of age) who were on FMDI were collected during regularly scheduled visits at a similar frequency over a 1-year period.Results. The total daily insulin dose did not change in CSII (0.97 ؎ 0.24 vs 0.91 ؎ 0.22 U/kg) and FMDI (0.98 ؎ 0.21 vs 0.97 ؎ 0.21 U/kg) patients, whereas the bolus: basal insulin ratio was significantly increased in both CSII (1.01 ؎ 0.43 vs 1.32 ؎ 0.52) and FMDI (1.07 ؎ 0.0.41 vs 1.29 ؎ 0.47) patients. The total cohort of CSII patients showed a decrease in HbA 1c from 8.4 ؎ 1.0% to 7.8 ؎ 0.8%, whereas the FMDI cohort did not show a significant change in HbA 1c (8.5 ؎ 1.1% to 8.2 ؎ 0.9%). However, 40% of the CSII group and 22.5% of the FMDI group showed >1.0% improvement in HbA 1c . Also, a similar number of patients in CSII (52.5%; 8.0 ؎ 1.1 to 7.2 ؎ 0.5%) and FMDI (47.5%; 8.0 ؎ 0.5% to 7.5 ؎ 0.4%) maintained or achieved target HbA 1c values <8.0%. The BMI increased significantly in the CSII group (21.6 ؎ 3.2 vs 23.0 ؎ 3.0 kg/m 2 ) but did not change in the FMDI group (21.9 ؎ 3.9 vs 22.6 ؎ 3.8 kg/m 2 ). There was a significant reduction in the rate of severe hypoglycemia (events/100 patientyears) in both cohorts: 20.6 to 8.2 in the CSII and 18.8 to 7.5 in the FMDI. Similarly, the rate of moderate hypoglycemia decreased in both CSII (68.3-35.4) and FMDI (56.3-30.4). I n recent years, significant changes have occurred in the management of type 1 diabetes. 1,2 Insulin replacement regimens now stress the importance of administering smaller doses of insulin throughout the day on the basis of flexibility in making food choices to fit individual lifestyles while focusing on improved metabolic control. 2 The use of carbohydrate counting has been used in a number of diabetic management regimens to aid in this flexibility. 3 Consequently, the goal of physiologic insulin replacement for type 1 diabetes has led to the development of better short-acting insulin analogues (lispro and aspart) that more closely mimic the sharp rise and short duration of pancreatic insulin secreted with nutrient intake. 4,5 Lispro (Humalog; Lilly, Indianapolis, IN) or aspart (Novolog; Novo Nordisk Pharmaceuticals, Princeton, NJ) insulin has been shown, for this purpose, to be an ideal mealtime insulin. [6][7][8][9] The use of the new long-acting basal insulin glargine (Lantus-Aventis Pharmaceuticals, Bridgewater, NJ) in a flexible multiple daily insulin (FMDI) regimen has been shown to enhance further ...

The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions, implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality.

CSII improved glycemic instability without reducing HbA(1c) or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.