Insulin and glucose profiles during continuous subcutaneous insulin infusion compared with injection of a long‐acting insulin in Type 2 diabetes¹

Abstract

Basal continuous subcutaneous infusion of a rapid-acting insulin analogue improved plasma insulin (more flat insulin profile with a lower variability) and glucose (lower AUC) profiles compared with once-daily subcutaneous injection of a long-acting insulin analogue in Type 2 diabetes.

Identifying and meeting the challenges of insulin therapy in type 2 diabetes

“…CSII may be best suited for technology-savvy patients with T1DM or T2DM who require multiple daily injections and who experience severe hypoglycemia or wide fluctuations in blood glucose levels throughout the day 133. Simple insulin dosing with CSII in patients with T2DM leads to improvements in glucose control, clinical outcomes, quality of life, and treatment satisfaction measures 120,134–136. In addition, comprehensive patient education and frequent SMBG or continuous glucose monitoring are necessary components of successful insulin pump therapy.…”

Glycemic Control During Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Type 2 Diabetes: Individual Patient Data Meta-analysis and Meta-regression of Randomized Controlled Trials

“…A likely mechanism for improved control on CSII is that the traditional large bolus injections of insulin required during MDI in type 2 diabetes are absorbed less well than the slow basal insulin infusion of CSII. In this respect, Parkner et al (19) found that the same dose of insulin given via the basal rate of CSII achieved better glycemic control and higher circulating insulin concentrations than when given as an injection of long-acting (glargine) insulin. Another reason for improved control with CSII may be the increased treatment satisfaction of insulin pump therapy in persons with type 2 diabetes (4), which may improve adherence to treatment compared with MDI.…”

The role of insulin pump therapy for type 2 diabetes mellitus

“… Predictable absorption of basal insulin: the large‐dose and therefore large volume of injected, long‐action insulin that is required in insulin‐resistant patients receiving MDI injections is more poorly and inconsistently absorbed compared to the small‐volume basal rate administered by CSII. It has been shown that the same dose of insulin delivered by CSII at the basal rate versus an injection of long‐acting insulin glargine achieved better glycemic control and higher circulating insulin levels with less fluctuation . Thus, the glycemic advantage of pump treatment probably relies mainly on better delivery of the basal component of insulin infusion. Better treatment satisfaction: treatment satisfaction in patients with T2DM is higher with CSII than with MDI injections, suggesting that adherence to treatment might be increased in those receiving pump therapy .…”