Long-Term Metabolic Control with Insulin Pump Therapy

Mecklenburg, Robert S.; Benson, E. A.; Benson, James W.; Blumenstein, Brent A.; Fredlund, Paul; Guinn, Terin S; Metz, Robert; Nielsen, Robert

doi:10.1056/nejm198508223130802

Cited by 74 publications

(31 citation statements)

References 7 publications

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“…Intensive management of diabetes is of great importance for improving longterm outcomes [1,2,36]. Using CSII regimes, it has been shown that rapid-acting human insulin analogs are effective in achieving and maintaining near-euglycemia [37,38]. In the present study, the patients responded to treatment with CSII with reductions in the levels of blood lipids, P-insulin, and required daily insulin doses, findings that support an improved insulin sensitivity [35].…”

Section: Discussionsupporting

confidence: 61%

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Increased plasma fibrin gel porosity in patients with Type I diabetes during continuous subcutaneous insulin infusion

Jörneskog

et al. 2003

Journal of Thrombosis and Haemostasis

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Summary. Background: Patients with Type 1 diabetes have a tighter plasma fibrin gel structure, to which impaired glycemic control might contribute. Improved glycemic control can be achieved with continuous subcutaneous insulin infusion (CSII). Objectives: The aim of the present study was to investigate the effect of CSII on plasma fibrin gel properties and circulating markers of inflammatory activity in patients with Type 1 diabetes. Patients and methods: Twenty-eight patients were investigated before and after 4-6 months' treatment with CSII. Fibrin gel structure formed in vitro from plasma samples was investigated by liquid permeation of hydrated fibrin gel networks. Pfibrinogen was analyzed by a syneresis method. Comparisons were made between patients with improved (> 0.5%) and unchanged (< 0.5%) glucosylated hemoglobin (HbA1c) during CSII. Results: Eighteen patients showed improved and 10 patients unchanged HbA 1c during CSII. P-fibrinogen, high sensitive C-reactive protein and serum amyloid A-antigen were not significantly changed, while fibrin gel permeability (Ks) and fiber mass-length ratio (m) increased in both groups (P < 0.02). P-insulin and triglycerides decreased (P < 0.05) in both groups, while reductions of total cholesterol and intercellular adhesion molecule-1 were seen only in patients with improved HbA 1c (P < 0.05). Absolute changes in Ks were inversely correlated to changes in plasma fibrinogen (r ¼ 0.50; P < 0.01) and in LDLcholesterol (r ¼ 0.46; P < 0.05). Conclusions: Treatment with CSII in patients with Type 1 diabetes is associated with increased plasma fibrin gel porosity. Slight attenuation of the inflammatory activity was also observed. The changes in fibrin gel porosity seem to be mainly mediated by changes in plasma fibrinogen and blood lipids, and are probably secondary to improved insulin sensitivity.

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Section: Discussionsupporting

confidence: 61%

“…Age was similar (P ¼ 0.82) in the two groups [improved HbA 1c 36 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) years; unchanged HbA 1c 36 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) years], as was diabetes duration, i.e. 20 (14-25) and 24 (15-28) years (P ¼ 0.85), respectively.…”

Section: Resultsmentioning

confidence: 92%

Increased plasma fibrin gel porosity in patients with Type I diabetes during continuous subcutaneous insulin infusion

Jörneskog

et al. 2003

Journal of Thrombosis and Haemostasis

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“…Mecklenburg et al 10 reported that 53% of adult patients discontinuing CSII therapy gave inflammation at the infusion site as their reason for quitting; infected infusion sites occurred in 29% of patients with a frequency of one infection every 27 patient-months, and there was a subgroup of patients who experienced repeated episodes of infection. 11 In the pediatric age group, Wood et al 12 reported that 21% of the children discontinuing CSII therapy cited infusion site issues as their reason for quitting.…”

Section: Figmentioning

confidence: 99%

Randomized Trial of Infusion Set Function: Steel Versus Teflon

Patel

Benasi²,

Ferrari³

et al. 2014

Diabetes Technology & Therapeutics

100

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Background: This study compared infusion set function for up to 1 week using either a Teflon Ò (Dupont Ô , Wilmington, DE) catheter or a steel catheter for insulin pump therapy in type 1 diabetes mellitus. Subjects and Methods: Twenty subjects participating in a randomized, open-labeled, crossover study were asked to wear two Quick-Set Ò and two Sure-T Ò infusion sets (both from Medtronic Minimed, Northridge, CA) until the infusion set failed or was worn for 1 week. All subjects wore a MiniMed continuous glucose monitoring system for the duration of the study. Results: One subject withdrew from the study. There were 38 weeks of Sure-T wear and 39 weeks of Quick-Set wear with no difference in the survival curves of the infusion sets. There was, however, a 15% initial failure rate with the Teflon infusion set. After 7 days, both types of infusion sets had a 64% failure rate. Overall, 30% failed because of hyperglycemia and a failed correction dose, 13% were removed for pain, 10% were pulled out by accident, 10% had erythema and/or induration of > 10 mm, 5% fell out because of loss of adhesion, and 4% were removed for infection. The main predictor of length of wear was the individual subject. There was no increase in hyperglycemia or daily insulin requirements when an infusion set was successfully used for 7 days (n = 25 of 77 weeks). Conclusions: We found no difference between steel and Teflon infusion sets in their function over 7 days, although 15% of Teflon sets failed because of kinking on insertion. The strongest predictor of prolonged 7-day infusion set function was the individual subject, not the type of infusion set.

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“…Technical advancements in insulin pump fabrication and the use of rapid-acting insulin analogs in recent years have increased the safety and efficacy of CSII to successfully attain normoglycemia (2). It is estimated that Ͼ500,000 patients worldwide are currently using CSII (3).…”

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confidence: 99%

Development of Gendine-Coated Cannula for Continuous Subcutaneous Insulin Infusion for Extended Use

Mohamed

Garoge

Rosenblatt

et al. 2015

Antimicrob Agents Chemother

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Continuous subcutaneous insulin infusion (CSII) using pumps is a widely used method for insulin therapy in patients with diabetes mellitus. Among the major factors that usually lead to the discontinuation of CSII are CSII set-related issues, including infection at the infusion site. The American Diabetic Association currently recommends rotating sites every 2 to 3 days. This recommendation adds cost and creates inconvenience. Therefore, in order to prevent infections and extend the duration between insertion site changes, we developed a Teflon cannula coated with a combination of gentian violet and chlorhexidine (gendine) and tested its antimicrobial efficacy against different pathogens. The cannulas were coated with gendine on the exterior surface and dried. The efficacy and durability of gendine-coated cannulas were determined against methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, methicillin-susceptible S. aureus, Streptococcus pyogenes, vancomycin-resistant enterococci, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and Candida glabrata using a biofilm colonization method. The cytotoxicity of gendine was assessed against mouse fibroblast cell lines. The gendine-coated cannulas showed complete prevention of biofilm colonization of all organisms tested for up to 2 weeks (P < 0.0001) compared to that with the uncoated control. A gendine-coated catheter against mouse fibroblast cells was shown to be noncytotoxic. Our in vitro results show that a novel gendine cannula is highly effective in completely inhibiting the biofilm of multidrug-resistant pathogens for up to 2 weeks and may have potential clinical applications, such as prolonged use, cost reduction, and lower infection rate. C ontinuous subcutaneous insulin infusion (CSII), a universally approved method, is used by an increasing number of both children and adults with diabetes (1). Technical advancements in insulin pump fabrication and the use of rapid-acting insulin analogs in recent years have increased the safety and efficacy of CSII to successfully attain normoglycemia (2). It is estimated that Ͼ500,000 patients worldwide are currently using CSII (3). Among the major factors that usually lead to the discontinuation of CSII therapy are CSII set-related issues, such as those related to the inconvenience of CSII therapy, which includes the need for frequent set changes, mechanical issues with infusion sets, skin problems at the site associated with pain and skin irritation from needle sticks, and infection at the infusion site (4-6). The use of CSII pumps by diabetic cancer patients while undergoing chemotherapy might improve their glycemic control and therapeutic outcomes; however, this frequently immunosuppressed and immunocompromised population has heightened susceptibility to infections (7,8).The American Diabetic Association (ADA) recommends changing the infusion set catheter at least every 3 days. Longer use of CSII is associated with microbial colonization and may consequently lead to infection. These recomme...

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Long-Term Metabolic Control with Insulin Pump Therapy

Cited by 74 publications

References 7 publications

Increased plasma fibrin gel porosity in patients with Type I diabetes during continuous subcutaneous insulin infusion

Increased plasma fibrin gel porosity in patients with Type I diabetes during continuous subcutaneous insulin infusion

Randomized Trial of Infusion Set Function: Steel Versus Teflon

Development of Gendine-Coated Cannula for Continuous Subcutaneous Insulin Infusion for Extended Use

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