A crossover comparison of continuous subcutaneous insulin infusion (CSII) against multiple insulin injections in insulin-dependent diabetic subjects: improved control with CSII

Abstract

Ten insulin-dependent C-peptide-negative diabetic subjects, whose control had been optimized on twice-daily injection therapy, were treated for periods of 10 wk in a crossover study, with either a thrice-daily subcutaneous insulin injection regimen (Actrapid + Ultratard) or by continuous subcutaneous insulin infusion (CSII). On CSII insulin dose stabilized at 51 +/- 5 U/day, compared with 80 +/- 9 U/day (P = 0.004) on the thrice-daily injection regimen, having been 60 +/- 6 U/day on twice-daily therapy. After 10 wk glycosylated hemoglobin was 11.7 +/- 0.6% on injection therapy and 10.0 +/- 0.7% (P = 0.026) on CSII. Mean blood glucose concentration and urinary glucose excretion were lower at most points during the study on CSII than on injection therapy. Patients on pumps gained weight compared with the thrice-daily injection regimen (P = 0.023 at 10 wk) and the previous twice-daily regimen, despite the reduction in insulin dose. Considering individual patients, four markedly improved on CSII compared with the previous twice-daily regimen and five compared with Actrapid + Ultratard. No patient showed impaired control on CSII compared with either injection regimen. The benefits of portable insulin infusion pumps over injection therapy are thus clearly demonstrable under outpatient conditions even with equal and intensive medical attention.

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

“…In seven [13,19,22,30,35,36,39] of these investigations, the difference was statistically significant. One study [20] did not find any difference between the treatment groups and another [16] showed insulin requirements to be higher under pump therapy, but without statistical significance.…”

“…Adult patients with type 1 diabetes mellitus Of 14 studies reporting total insulin requirements at the end of treatment, 12 [13,19,22,24,28,30,[33][34][35][36][37]39] consistently found that the insulin doses were lower in CSII-treated patients. In seven [13,19,22,30,35,36,39] of these investigations, the difference was statistically significant.…”

“…Four of 17 studies [16,19,20,30] did not mention severe hypoglycaemic episodes. Three others [33,35,36] reported that no severe hypoglycaemia was observed.…”

“…Two other studies [30,37] presented results for overall hypoglycaemia only, but for the latter [37] the rate of mild/minor hypoglycaemic events could be calculated because exact numbers of severe events were available. Six studies [21,22,24,28,36,39] provided the event rates for mild/minor hypoglycaemia per patient per time period, which ranged from 0.9 to 3.1 weekly events per patient in the CSII groups and from 1.1 to 3.3 in the MDI groups (ranges include previously mentioned study [37]).…”

Intensive insulin therapy in clinical practice

“…As a result a series of studies addressed the question of whether multiple injection therapy had the same potential as continuous subcutaneous insulin infusion for improving blood glucose control [9][10][11]. In designing these studies the authors adopted to a greater or lesser degree some of the principles that have since become enshrined as components of intensive therapy, in particular as applied to the various studies of the effect of tight control on the evolution of microvascular complications.…”