Diabetes Care, Vol 19, Issue 4 324-327, Copyright © 1996 by American Diabetes Association

ARTICLES

Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type I diabetes

BW Bode, RD Steed and PC Davidson
Atlanta Diabetes Associates, Georgia, USA. jholstad.aol.com

OBJECTIVE: To compare the incidence of severe hypoglycemia in patients crossed over from multiple daily injections (MDIs) of insulin to continuous subcutaneous insulin infusion (CSII). RESEARCH DESIGN AND METHODS: From a population of 225 patients using CSII, all patients who met the following selection criteria were included in the present study: 1) a minimum of 12 months on intensive therapy with MDIs before switching to CSII, and 2) a minimum of 12 months on CSII after crossover. Glycemic control and adverse event rates for the 1-year MDI control period were compared with those for the CSII therapy period. RESULTS: The incidence of severe hypoglycemia during MDI therapy declined from 138 to 22 events per 100 patient-years during the 1st year of CSII (P < 0.0001) and remained significantly lower in years 2, 3, and 4 on CSII (26, 39, and 36, respectively). HbA1c levels did not change significantly between the MDI phase and any year on CSII. However, in the subgroup of patients who had pre-CSII HbA1c levels of > or = 8.0%, the change to CSII was associated with a significant reduction in HbA1c from baseline to year 1 (8.9 +/- 0.8 vs. 8.1 +/- 1.0%, P = 0.0004). The difference in diabetic ketoacidosis rates between the MDI year (14.6 events per 100 patient-years) and the CSII period (7.2 events per 100 patient-years) was not statistically significant. CONCLUSIONS: CSII therapy was associated with a marked and sustained reduction in the rate of severe hypoglycemia without adversely affecting the level of glycemic control attained during MDI therapy. The more reproducible and flexible insulin delivery afforded by CSII was considered to be the major factor contributing to the improvement in severe hypoglycemia rates.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				J. C. Pickup and E. Renard Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 Diabetes Diabetes Care, February 1, 2008; 31(Supplement_2): S140 - S145. [Abstract] [Full Text] [PDF]

				J. S. Skyler, S. Ponder, D. F. Kruger, D. Matheson, and C. G. Parkin Is There a Place for Insulin Pump Therapy in Your Practice? Clin. Diabetes, April 1, 2007; 25(2): 50 - 56. [Abstract] [Full Text] [PDF]

				M. R. Battaglia, R. Alemzadeh, H. Katte, P. L. Hall, and L. C. Perlmuter Brief Report: Disordered Eating and Psychosocial Factors in Adolescent Females with Type 1 Diabetes Mellitus J. Pediatr. Psychol., July 1, 2006; 31(6): 552 - 556. [Abstract] [Full Text] [PDF]

				J. C. Pickup Point: Are Insulin Pumps Underutilized in Type 1 Diabetes? Yes. Diabetes Care, June 1, 2006; 29(6): 1449 - 1452. [Full Text] [PDF]

				R. Nimri, N. Weintrob, H. Benzaquen, R. Ofan, G. Fayman, and M. Phillip Insulin pump therapy in youth with type 1 diabetes: a retrospective paired study. Pediatrics, June 1, 2006; 117(6): 2126 - 2131. [Abstract] [Full Text] [PDF]

				L. K. Fisher and M. Halvorson Future Developments in Insulin Pump Therapy: Progression From Continuous Subcutaneous Insulin Infusion to a Sensor-Pump System The Diabetes Educator, January 1, 2006; 32(1): 47S - 52S. [Full Text] [PDF]

				G. Lepore, A. R. Dodesini, I. Nosari, and R. Trevisan Age and A1C Are Important Clinical Predictors of Continuous Subcutaneous Insulin Infusion Efficacy in Type 1 Diabetic Patients Diabetes Care, July 1, 2005; 28(7): 1834 - 1835. [Full Text] [PDF]

				T. Richardson, P. Thomas, J. Ryder, and D. Kerr Influence of Caffeine on Frequency of Hypoglycemia Detected by Continuous Interstitial Glucose Monitoring System in Patients With Long-Standing Type 1 Diabetes Diabetes Care, June 1, 2005; 28(6): 1316 - 1320. [Abstract] [Full Text] [PDF]

				I. B. Hirsch, B. W. Bode, S. Garg, W. S. Lane, A. Sussman, P. Hu, O. M. Santiago, J. W. Kolaczynski, and for the Insulin Aspart CSII/MDI Comparison Study G Continuous Subcutaneous Insulin Infusion (CSII) of Insulin Aspart Versus Multiple Daily Injection of Insulin Aspart/Insulin Glargine in Type 1 Diabetic Patients Previously Treated With CSII Diabetes Care, March 1, 2005; 28(3): 533 - 538. [Abstract] [Full Text] [PDF]

				N. Weintrob, A. Schechter, H. Benzaquen, S. Shalitin, P. Lilos, A. Galatzer, and M. Phillip Glycemic Patterns Detected by Continuous Subcutaneous Glucose Sensing in Children and Adolescents With Type 1 Diabetes Mellitus Treated by Multiple Daily Injections vs Continuous Subcutaneous Insulin Infusion Arch Pediatr Adolesc Med, July 1, 2004; 158(7): 677 - 684. [Abstract] [Full Text] [PDF]

				P. Hammond Continuous subcutaneous insulin infusion: short-term benefits apparent, long-term benefits speculative The British Journal of Diabetes & Vascular Disease, March 1, 2004; 4(2): 104 - 108. [Abstract] [PDF]

				K. M. Stewart, M. F. Wilson, and J. M. Rider Insulin Delivery Devices Journal of Pharmacy Practice, February 1, 2004; 17(1): 20 - 28. [Abstract] [PDF]

				S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]

				Continuous Subcutaneous Insulin Infusion Diabetes Care, January 1, 2004; 27(90001): s110 - 110. [Full Text] [PDF]

				P. Raskin, B. W. Bode, J. B. Marks, I. B. Hirsch, R. L. Weinstein, J. B. McGill, G. E. Peterson, S. R. Mudaliar, and R. R. Reinhardt Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes: A randomized, parallel-group, 24-week study Diabetes Care, September 1, 2003; 26(9): 2598 - 2603. [Abstract] [Full Text] [PDF]

				J. Weissberg-Benchell, J. Antisdel-Lomaglio, and R. Seshadri Insulin Pump Therapy: A meta-analysis Diabetes Care, April 1, 2003; 26(4): 1079 - 1087. [Abstract] [Full Text] [PDF]

				B. Guerci, M. Benichou, M. Floriot, P. Bohme, S. Fougnot, P. Franck, and P. Drouin Accuracy of an Electrochemical Sensor for Measuring Capillary Blood Ketones by Fingerstick Samples During Metabolic Deterioration After Continuous Subcutaneous Insulin Infusion Interruption in Type 1 Diabetic Patients Diabetes Care, April 1, 2003; 26(4): 1137 - 1141. [Abstract] [Full Text] [PDF]

				Continuous Subcutaneous Insulin Infusion Diabetes Care, January 1, 2003; 26(90001): s125 - 125. [Full Text] [PDF]

				L. Meyer, P. Bohme, I. Delbachian, P. Lehert, N. Cugnardey, P. Drouin, and B. Guerci The Benefits of Metformin Therapy During Continuous Subcutaneous Insulin Infusion Treatment of Type 1 Diabetic Patients Diabetes Care, December 1, 2002; 25(12): 2153 - 2158. [Abstract] [Full Text] [PDF]

				J. A. Sanfield, M. Hegstad, and R. S. Hanna Protocol for Outpatient Screening and Initiation of Continuous Subcutaneous Insulin Infusion Therapy: Impact on Cost and Quality The Diabetes Educator, July 1, 2002; 28(4): 599 - 607. [Abstract] [PDF]

				J. Pickup, M. Mattock, and S. Kerry Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials BMJ, March 23, 2002; 324(7339): 705 - 705. [Abstract] [Full Text] [PDF]

				B. Bode, R. Weinstein, D. Bell, J. McGill, D. Nadeau, P. Raskin, J. Davidson, R. Henry, W.-C. Huang, and R. R. Reinhardt Comparison of Insulin Aspart With Buffered Regular Insulin and Insulin Lispro in Continuous Subcutaneous Insulin Infusion: A randomized study in type 1 diabetes Diabetes Care, March 1, 2002; 25(3): 439 - 444. [Abstract] [Full Text] [PDF]

				J. Pickup and H. Keen Continuous Subcutaneous Insulin Infusion at 25 Years: Evidence base for the expanding use of insulin pump therapy in type 1 diabetes Diabetes Care, March 1, 2002; 25(3): 593 - 598. [Abstract] [Full Text] [PDF]

				K. Kamoi Good Long-Term Quality of Life Without Diabetic Complications With 20 Years of Continuous Subcutaneous Insulin Infusion Therapy in a Brittle Diabetic Elderly Patient Diabetes Care, February 1, 2002; 25(2): 402 - 404. [Full Text]

				A. E. Kitabchi Response to Kirkman and Juneja and Lorber Diabetes Care, November 1, 2001; 24(11): 2010 - 2011. [Full Text] [PDF]

				M. J. Lenhard and G. D. Reeves Continuous Subcutaneous Insulin Infusion: A Comprehensive Review of Insulin Pump Therapy Arch Intern Med, October 22, 2001; 161(19): 2293 - 2300. [Abstract] [Full Text] [PDF]

				E. Tsui, A. Barnie, S. Ross, R. Parkes, and B. Zinman Intensive Insulin Therapy With Insulin Lispro: A randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection Diabetes Care, October 1, 2001; 24(10): 1722 - 1727. [Abstract] [Full Text] [PDF]

				J. Pickup and H. Keen Continuous subcutaneous insulin infusion in type 1 diabetes BMJ, May 26, 2001; 322(7297): 1262 - 1263. [Full Text] [PDF]

				A. K. Maniatis, G. J. Klingensmith, R. H. Slover, C. J. Mowry, and H. P. Chase Continuous Subcutaneous Insulin Infusion Therapy for Children and Adolescents: An Option for Routine Diabetes Care Pediatrics, February 1, 2001; 107(2): 351 - 356. [Abstract] [Full Text]

				B. W. Bode and P. Strange Efficacy, Safety, and Pump Compatibility of Insulin Aspart Used in Continuous Subcutaneous Insulin Infusion Therapy in Patients With Type 1 Diabetes Diabetes Care, January 1, 2001; 24(1): 69 - 72. [Abstract] [Full Text]

				B. Guerci, L. Meyer, A. Sallé, A. Charrié, B. Dousset, O. Ziegler, and P. Drouin Comparison of Metabolic Deterioration between Insulin Analog and Regular Insulin after a 5-Hour Interruption of a Continuous Subcutaneous Insulin Infusion in Type 1 Diabetic Patients J. Clin. Endocrinol. Metab., August 1, 1999; 84(8): 2673 - 2678. [Abstract] [Full Text]