Efficacy of Continuous Subcutaneous Insulin Infusion in Type 2 Diabetes Mellitus: A Survey on a Cohort of 102 Patients with Prolonged Follow-Up

Reznik, Yves; Morera, J.; Rod, A.; Coffin, C.; Rousseau, E.; Lireux, B.; Joubert, Michaël

doi:10.1089/dia.2010.0110

Cited by 46 publications

(55 citation statements)

References 19 publications

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“…This finding was consistent with other studies comparing baseline HbA1c to 12 months post-CSII initiation4,5,7. Of note, our baseline mean HbA1c pre-CSII was lower (8.69%) compared to other baseline HbA1c values from transitional studies3,5,7, thus the absolute mean HbA1c reduction of −1.17% was impressive. We also stratified HbA1c across 3-month intervals post-CSII over 12 months to assess the sustainability of glycemic control following conversion.…”

Section: Discussionsupporting

confidence: 92%

“…Outcomes from most investigations directly comparing CSII vs MDI have demonstrated an overall reduction in HbA1c with CSII between the two methods6,8,22. Outcomes from transitional studies include improved glycemic control after switching from MDI to CSII3–5,7. Further results from studies demonstrate that, while CSII therapy has improved glycemic control, there has not been a causative increase in minor or severe hypoglycemia events which is an important patient safety concern4,6.…”

Section: Discussionmentioning

confidence: 99%

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Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Ledford

Hess

Johnson³

2013

Journal of Drug Assessment

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ObjectiveTo measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist.Research design and methodsThis study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services.ResultsTwenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m2 pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001).ConclusionsPharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician–pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Ledford

Hess

Johnson³

2013

Journal of Drug Assessment

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“…Учитывая возможное повышение качества жизни при ис-пользовании ППИИ, у врачей должны быть не только основания для назначения, но и причины для неназна-чения ППИИ пациентам с СД2, в том числе молодым. Особенно это актуально в свете результатов публикуемых исследований, подтверждающих преимущества ППИИ для лечения СД2 [14,6].…”

Section: Discussionunclassified

“…Часть из них убедительно демонстрирует не только улучшение пока-зателей гликемического контроля [6], но и различных аспектов качества жизни и удовлетворенности лечением при использовании ППИИ в сравнении с МИИ [7,8]. Од-нако работ, оценивающих эффекты ППИИ у пациентов с СД2 при длительном наблюдении, очень мало [3,14], что затрудняет создание оптимального протокола отбора пациентов и их ведения.…”

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Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study

et al. 2015

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Цель. Оценить эффективность инсулинотерапии в режиме постоянной подкожной инфузии инсулина (ППИИ) для лече-ния пациентов с сахарным диабетом 2 типа (СД2) при длительном наблюдении. Определить предикторы эффективности ППИИ в отношении улучшения показателей гликемического контроля (снижение

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“…Similarly, a recent review that examined the evidence base for CSII in type 2 diabetes 11 included data from 4 randomized controlled trials (RCTs) [12][13][14][15] and 5 open-label observational studies [16][17][18][19][20] (2 prospective and 3 retrospective). Two RCTs showed a relative HbA1c benefit with CSII versus MDI in obese patients with poor baseline glycemic control and high insulin requirements, 14,15 but the other 2 trials showed no clear benefit for CSII.…”

mentioning

confidence: 99%

Do We Need Updated Guidelines on the Use of Insulin Pump Therapy in Type 2 Diabetes? A Review of National and International Practice Guidelines

Cohen

Valentine²

2016

J Diabetes Sci Technol

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The management of type 2 diabetes mellitus remains a significant health care challenge. Despite evidence from landmark clinical trials and recommendations in published guidance, glycemic control is often poor for patients in clinical practice and insulin therapy can be delayed or is not optimized.1 Barriers to the initiation and intensification of insulin therapy include the known side effects, such as weight gain and increased risk of hypoglycemia, concerns over the complexity of the treatment regimen, and fear of injections.2-5 The implications of reluctance to initiate and intensify insulin therapy have been described in the primary care setting. 6,7 Analyses suggest that at least 40% of individuals initiating insulin failed to achieve target glycated hemoglobin (HbA1c) levels of ≤7.5% (58 mmol/mol), with average time-to-insulin initiation >11.5 years from diagnosis, suggesting that patients frequently fail to meet glycemic control targets with insulin therapy.Intensification of the insulin regimen to control hyperglycemia is traditionally achieved in type 2 diabetes with basalbolus insulin therapy (short-acting prandial insulin, together with long-acting insulin injections such as glargine or detemir), also known as multiple daily injections (MDI) of insulin. However, MDI regimens can be overwhelming and unpopular with a large number of patients, and despite combination with metformin, many patients still fail to achieve good glycemic control. Comorbidities such as obesity and hypertension are very common and weight gain associated Abstract Background: Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. Methods:A literature review was performed to identify published national and international guidelines on type 2 diabetes management. Searches were performed using PubMed, Cochrane Library, and Embase databases, and websites of national health care agencies, reimbursement agencies, and professional associations. Searches were limited to articles published in English between 2004 and 2014 and 1666 unique hits were identified, of which 22 were reviewed following screening.Results: Only 6 of the 22 guidelines identified from North and South America, Western Europe, Greece, and Israel provided specific recommendations on intensive insulin therapy and the role of CSII, and only 1 provided information on the grade of evidence supporting recommendations. Quality appraisal based on the AGREE II tool suggested that published guidelines may have limitations in terms of search methodology and evidence grading, and findings were of mixed rigor and clarity. Only 3 guidelines described the population for whom CSII may be appropriate. Conclusions:Guidelines need to improve the evidence base, rigor, clarity, and gra...

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Efficacy of Continuous Subcutaneous Insulin Infusion in Type 2 Diabetes Mellitus: A Survey on a Cohort of 102 Patients with Prolonged Follow-Up

Cited by 46 publications

References 19 publications

Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study

Do We Need Updated Guidelines on the Use of Insulin Pump Therapy in Type 2 Diabetes? A Review of National and International Practice Guidelines

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