Improved A1C by switching to continuous subcutaneous insulin infusion from injection insulin therapy in type 2 diabetes: A retrospective claims analysis

Lynch, Peter; Riedel, Aylin Altan; Samant, Navendu; Fan, Ying; Peoples, Tim; Levinson, Jenifer; Lee, Scott W.

doi:10.1016/j.pcd.2010.07.004

Cited by 11 publications

(15 citation statements)

References 15 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.…”

Section: Discussionsupporting

confidence: 92%

“…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. Finally, CSII-based therapy has resulted in a reduction in albumin excretion rates22 and improved patient quality-of-life9.…”

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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“…Good candidates for CSII therapy include patients who experience recurrent severe hypoglycemia or wide swings in blood glucose levels (regardless of their HbA 1c levels), those who have poor glycemic control or microvascular complications and/or risk factors for macrovascular complications, or those whose metabolic control is adequate but whose quality of life is adversely affected by a multiple daily injection regimen [36][37][38][39][40]. Good candidates for CSII therapy with rapid-acting insulin analogs are patients with type 1 diabetes poorly controlled with multiple daily injections and prone to hypoglycemia [19,[41][42][43][44][45][46] and patients with type 2 diabetes who are obese and uncontrolled on a high insulin dose [43,[47][48][49][50]. Patients with type 1 and type 2 diabetes with high baseline HbA 1c levels (>8.5 %) generally experience greater improvement in glycemic control and greater dose efficiency on CSII than with multiple daily injections [42,44,48,[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] (Fig.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Realization of many of these advantages is generally contingent upon the use of rapid-acting insulin analogs in CSII. Intensive insulin therapy in general may pose an increased risk of hypoglycemia; however, several studies of rapid-acting insulin analogs in CSII therapy show either no increase or a reduction of risk of hypoglycemia compared with conventional insulin treatment with MDI therapy [42,44,48,50,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] (Tables 2 and 3).…”

Section: Potential Clinical Advantages Of Csiimentioning

confidence: 99%

“…The efficacy of CSII therapy with rapid-acting insulin analogs is particularly striking in studies of type 1 diabetes, where it has been proven a safe and effective alternative to multiple daily injections in various patient populations, including children and adolescents [48,49,[55][56][57]59], adults [42,44,55,56,[59][60][61]68,69], the elderly [58,61,62,71], and pregnant women [54,57] (Tables 2 and 3). IAsp and ILisp are labeled for use in each of these patient populations [34,72], supported by studies using multiple daily injections or CSII therapy [73][74][75][76].…”

Section: Clinical Performance Of Csii In Cont-rolled Studies: Type 1 mentioning

confidence: 99%

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Continuous Subcutaneous Insulin Infusion Therapy with Rapid-Acting Insulin Analogs in Insulin Pumps: Does it Work, How Does it Work, and what Therapies Work Better than Others?

Marcus¹

2013

TODIAJ

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Many patients are not optimally controlled on conventional insulin regimens. This review evaluates the practicalities and clinical success of continuous subcutaneous insulin infusion therapy with rapid-acting insulin analogs in insulin pumps in patients with type 1 and type 2 diabetes. In contrast to a multiple daily injection regimen, CSII provides patients with greater flexibility in the timing of meals and insulin dosing, resulting in improved quality of life and greater treatment adherence. CSII therapy with rapid-acting insulin analogs offers reliable glycemic control and proactive response to glucose variability, with a reduced risk of weight gain and hypoglycemia compared with regular human insulin in CSII. While the clinical benefits of CSII versus multiple daily injection therapy in patients with type 1 diabetes are quite evident in studies in appropriately-selected patients, the benefits are more equal in patients with type 2 diabetes. Appropriate patient selection for CSII therapy may help ensure successful outcomes in diabetes treatment. Patients who are very poorly controlled on multiple daily injections may benefit from CSII therapy, with the greatest glycemic improvement associated with high baseline HbA 1c levels. CSII therapy may be of particular benefit to patients with type 1 diabetes who are prone to hypoglycemia and patients with type 2 diabetes who are obese and uncontrolled on high doses of insulin; however, most important as a predictor of success is that patients desire CSII therapy.

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Cost-Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Patients with Poorly Controlled Type 2 Diabetes in Finland

Roze¹,

Smith-Palmer²,

Delbaere

et al. 2019

Diabetes Ther

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Introduction Although primarily utilized in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) represents a useful treatment alternative for patients with type 2 diabetes who are unable to achieve good glycemic control despite optimization of multiple daily injections (MDI). The aim of the analysis reported here was to investigate the long-term cost-effectiveness of CSII versus MDI in type 2 diabetes patients with poor glycemic control in Finland. Methods The IQVIA CORE Diabetes Model was used to make long-term projections of the clinical and economic outcomes associated with CSII use in type 2 diabetes, based on clinical input data from the OpT2mise trial, which showed that CSII was associated with a 1.1% decrease in glycated hemoglobin (HbA1c) in patients with poor glycemic control at baseline. The analysis was performed from a societal perspective and the time horizon was that of patient lifetimes. Future costs and clinical outcomes were discounted at 3% per annum. Results Continuous subcutaneous insulin infusion was associated with a gain in quality-adjusted life expectancy of 0.32 quality-adjusted life-years (QALYs) compared with MDI (8.15 vs. 7.83 QALYs, respectively), as well as higher mean lifetime costs, resulting in an incremental cost-effectiveness ratio of Euro (EUR) 47,834 per QALY gained for CSII versus MDI. The higher treatment costs in the CSII group were partly mitigated by a 15% reduction in diabetes-related complication costs. Sensitivity analyses demonstrated that CSII was most cost-effective in patients with the highest baseline HbA1c values. Conclusion In Finland, CSII is likely to represent a cost-effective treatment alternative for patients with type 2 diabetes with poor glycemic control despite optimization of MDI. In such patients, CSII is associated with improved clinical outcomes relative to MDI, with the higher acquisition costs partly offset by a lower lifetime incidence and cost of diabetes-related complications. Funding Medtronic International Sàrl.

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Improved A1C by switching to continuous subcutaneous insulin infusion from injection insulin therapy in type 2 diabetes: A retrospective claims analysis

Cited by 11 publications

References 15 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

Continuous Subcutaneous Insulin Infusion Therapy with Rapid-Acting Insulin Analogs in Insulin Pumps: Does it Work, How Does it Work, and what Therapies Work Better than Others?

Cost-Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Patients with Poorly Controlled Type 2 Diabetes in Finland

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