Continuous Subcutaneous Insulin Infusion (Mill-Hill Infuser) Versus Multiple Injections (Medi-Jector) in the Treatment of Insulin-dependent Diabetes Mellitus and the Effect of Metabolic Control on Microangiopathy

Abstract

The present study was designed to compare continuous subcutaneous insulin infusion (CSII) using the Mill-Hill Infuser (Muirhead Medical Products Ltd., London, England) with multiple injections (MI) using the Medi-Jector (Derata Corporation, Minneapolis, Minnesota) in the treatment of insulin-dependent diabetes mellitus (IDDM), and to assess the effect of glucose control on diabetes complications. Twelve diabetic subjects were treated 3 mo with CSII and 3 mo with MI (bedtime ultralente and premeal boluses of regular insulin) in a randomized fashion. Prestudy preprandial/postprandial glucose levels were 147-215 mg/dl and improved to 108-138 mg/dl during CSII, and to 115-139 mg/dl during MI with glycosylated hemoglobin of 12.9%, 9.1%, and 8.7%, respectively. This improved glucose control with either CSII or MI was associated with an increase in sural nerve conductivity from 42.9 to 45 m/s and a decrease in proteinuria from 1.9 to 0.5 g/24 h. The 24-h insulin dose consisted of 45 U before the study, 44 U during CSII, and 56 U during MI. After the study, seven patients opted to continue with the Mill-Hill Infuser, and five with the Medi-Jector. We conclude the following: (1) treatment with both the Mill-Hill Infuser and the Medi-Jector was well accepted by the patients and resulted in similar improvement in measured blood glucose and glycosylated hemoglobin; (2) this improved metabolic control was associated with an increased nerve conductivity and a decreased protein excretion; and (3) MI required 20% more insulin than CSII to achieve similar glycemic control.

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.…”

“…Mild/minor/symptomatic hypoglycaemia in adult patients with type 1 diabetes mellitus In six of 17 studies [13,16,19,20,33,35] there were no reports on mild, minor or symptomatic hypoglycaemic events. 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.…”

Insulin delivery by injection in children and adolescents with diabetes

“…The insulin is absorbed quickly and glucose control achieved using this method can equal that achieved by an insulin pump (71,72). Jet injectors have been reported to decrease injection pain (73), but this finding has been contradicted in other studies (74,75).…”