Insulin pump therapy in type 1 diabetes mellitus

Liberatore, Raphael Del Roio; Damiani, Durval

doi:10.2223/jped.1507

Cited by 13 publications

(6 citation statements)

References 40 publications

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“…The ideal insulin replacement program should mimic the above endogenous system [47]. The basal secretion is reproduced by the constant slow infusion of rapid-acting analogues.…”

Section: Continuous Subcutaneous Insulin Infusion (Csii)mentioning

confidence: 99%

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Valla

2010

Experimental Diabetes Research

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Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.

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“…The ideal insulin replacement program should mimic the above endogenous system [47]. The basal secretion is reproduced by the constant slow infusion of rapid-acting analogues.…”

Section: Continuous Subcutaneous Insulin Infusion (Csii)mentioning

confidence: 99%

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Valla

2010

Experimental Diabetes Research

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“…In spite of the knowledge about both, MDI5 – 7 and CIIT,7 the comparison between these therapeutic schemes, particularly among children and adolescents, is incipient. Several studies have suggested that CIIT may provide better glycemic control,8 – 11 with lower risk of severe hypoglycemia and a smaller weight gain8 compared to the MDI therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Apesar do conhecimento sobre ambos, MDI5 – 7 e SIC,7 a comparação entre esses esquemas terapêuticos, especialmente entre as crianças e adolescentes, é incipiente. Vários estudos têm sugerido que o SIC pode proporcionar um melhor controle glicêmico,8 – 11 com menor risco de hipoglicemia grave, e menor ganho de peso em comparação com a terapia com MDI.…”

Section: Introductionunclassified

Insulinoterapia contínua versus múltiplas injeções de insulina no tratamento da diabetes tipo 1: um estudo longitudinal

Ribeiro

Liberatore

Custódio

et al. 2016

Revista Paulista de Pediatria

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This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.

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“…The DCCT study (The Diabetes Control and Complications Trial Research Group) 4 demonstrated that intensive insulin therapy with multiple doses of insulin (MDI) or with a continuous insulin infusion therapy (CIIT) would be the best treatment for T1DM. In spite of the knowledge about both, MDI 5 – 7 and CIIT, 7 the comparison between these therapeutic schemes, particularly among children and adolescents, is incipient. Several studies have suggested that CIIT may provide better glycemic control, 8 – 11 with lower risk of severe hypoglycemia and a smaller weight gain 8 compared to the MDI therapy.…”

Section: Introductionmentioning

confidence: 99%

Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study

Ribeiro

Liberatore

Custódio

et al. 2016

Revista Paulista de Pediatria (English Edition)

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Objective:To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes mellitus.Methods:40 patients with type 1 diabetes mellitus (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period).Results:Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15–40 patients have severe hypoglycemic events versus 5–40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded.Conclusions:This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy.

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Insulin pump therapy in type 1 diabetes mellitus

Abstract: The development of infusion pumps and glucose monitors, including continuous monitoring systems, will lead to "intelligent pumps," so that a true "artificial pancreas" will be available, which can even be implanted in the patient, allowing non-diabetic persons to lead a normal life.

Cited by 13 publications

References 40 publications

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Therapeutics of Diabetes Mellitus: Focus on Insulin Analogues and Insulin Pumps

Insulinoterapia contínua versus múltiplas injeções de insulina no tratamento da diabetes tipo 1: um estudo longitudinal

Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study

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