Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Regimens in Children With Type 1 Diabetes: A Randomized Open Crossover Trial

Weintrob, Naomi; Benzaquen, Hadassa; Galatzer, Avinoam; Shalitin, Shlomit; Lazar, Liora; Fayman, Gila; Lilos, Pearl; Dickerman, Z; Phillip, Moshe

doi:10.1542/peds.112.3.559

Cited by 222 publications

(224 citation statements)

References 24 publications

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“…Several randomized clinical trials, usually on small samples of patients, comparing CSII using short-acting analogs and multiple daily injections (MDI) have been performed, reporting either a similar efficacy of the two approaches [6][7][8][9][10][11][12][13][14][15][16] or a superiority of CSII [17,18]. A meta-analysis on patient-level data from three clinical trials suggests an improvement of HbA1c with CSII (with lispro) as compared with MDI [19].…”

Section: Introductionmentioning

confidence: 99%

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis

et al. 2009

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Continuous subcutaneous insulin infusion (CSII) is considered an option for type 1 diabetic patients unsatisfactorily controlled with multiple daily injections (MDI). Short-acting analogs are superior to regular human insulin in CSII. This meta-analysis is aimed at assessing the advantages of short-acting analog-based CSII over MDI in type 1 diabetes. Randomized clinical trials (RCTs) comparing CSII (with analogs) and MDI for at least 12 weeks in type 1 diabetic patients were retrieved, assessing between-group differences in HbA1c and incidence of hypoglycemia. A total of 11 RCTs was included in the analysis. CSII was associated with a significant improvement of HbA1c in comparison with MDI (standardized difference in mean: -0.3 [-0.4;-0.1]%; P \ 0.001). No significant difference was observed in the rate of severe hypoglycemic episodes. The reduction of HbA1c with CSII was evident in trials enrolling patients with mean age greater than 10 years, but not in younger children. Available data justify the use of CSII for basal-bolus insulin therapy in type 1 diabetic patients unsatisfactorily controlled with MDI.

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Section: Introductionmentioning

confidence: 99%

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis

et al. 2009

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“…The average type 1 diabetic patient requires insulin substitution in the range of 0.5 to 1.0 IE/kg BW per day (Weintrob et al, 2003), in order to achieve normoglycaemia, compared to the insulin doses of 5 IE/kg BW per day, which were administered in the present study without rendering the rats normoglycaemic. The dose used in the present study is about 30 times the dose a diabetic patient would need before a meal (Ahmed et al, 1998).…”

Section: Discussionmentioning

confidence: 83%

Improvement of insulin response in the streptozotocin model of insulin-dependent diabetes mellitus. Insulin response with and without a long-acting insulin treatment

Nordquist

Sjöquist

2009

Animal

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Streptozotocin-induced diabetes mellitus (STZ-DM) in rats is a model of type 1 diabetes, which is commonly used to study diabetes, but differs from human diabetic pathophysiology in its insulin resistance. An STZ-DM rat can be administered five times the dose of insulin compared to that of a diabetic patient. Thus, attaining normoglycaemia in STZ-DM rats with insulin injections is complicated, and it involves an obvious risk of overdosing before getting a response. This study was designed to investigate whether suboptimal treatment with long-acting insulin restores insulin sensitivity in the STZ-DM rat, and thus an approach to more closely mimic the human condition. Male Sprague-Dawley rats were made diabetic by means of a single intravenous injection of STZ (55 mg/kg body weight (BW)), resulting in an increase in blood glucose (BG) from 6.5 6 0.2 to 22.5 6 1.0 mmol/l ( P < 0.05) within 24 h. After treating the STZ-DM rats with vehicle for 14 days, BG was 26.1 6 1.1 mmol/l, and the response to a single injection of fast-acting insulin (Humalog, 5 IE/kg BW) was a 23% reduction in BG. Thereafter, the rats were treated daily with a suboptimal dose of long-acting insulin for a total of 7 days (Insulatard, 5 IE/kg per day), which resulted in a BG level of 19.4 6 2.7. The response to fast-acting insulin after the suboptimal treatment was a 61% reduction in BG. Thereafter, the animals were vehicle-treated for another 7 days, which resulted in a response to fast-acting insulin similar to the initial values (234%). Furthermore, the group treated with suboptimal doses of long-acting insulin had a longer duration of the reduction in BG (150 min, as opposed to 90 min in the vehicle-treated groups). We conclude that the development of a decreased insulin response occurs rapidly within the first 2 weeks after the onset of diabetes in STZ-DM rats. This leads to a brief and significantly reduced decrease in BG when fast-acting insulin is administered. The insulin response is increased by treatment with suboptimal doses of long-acting insulin, but rapidly decreases again when treatment is withdrawn. Regular administration of suboptimal insulin doses may provide an approach to eliminate the effects of a lowered insulin response.

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“…There is evidence to show that some children and adolescents develop ketoacidosis as a result of poor adherence to insulin therapy (24,25). The level and need for self-care also differs with age; children with diabetes who were diagnosed at an older age have been reported to have more success with self-care (22).…”

Section: Use Of Insulin Pens In the Paediatric Populationmentioning

confidence: 99%

“…When adolescents use pump therapy, it is not uncommon for them to forget to administer bolus insulin before/after eating a meal (27). Besides, children and adolescents tend to eat irregularly, and missed bolus insulin doses may counterbalance the advantage of the basal insulin replacement offered by CSII (25). Indeed, parents play a key role in CSII management (66) and lack of support for parents or proper training may prevent improvements in glucose control.…”

Section: Insulin Pumpsmentioning

confidence: 99%

Insulin delivery by injection in children and adolescents with diabetes

Hanås¹,

Beaufort²,

Hoey³

et al. 2011

Pediatric Diabetes

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Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Regimens in Children With Type 1 Diabetes: A Randomized Open Crossover Trial

Abstract: Intensive insulin therapy by either insulin pump or MDI is safe in children and young adolescents with type 1 diabetes, with similar diabetes control and a very low rate of adverse events. We suggest that both modes be available to the diabetic team to better tailor therapy.

Cited by 222 publications

References 24 publications

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis

Improvement of insulin response in the streptozotocin model of insulin-dependent diabetes mellitus. Insulin response with and without a long-acting insulin treatment

Insulin delivery by injection in children and adolescents with diabetes

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