The impact of continuous subcutaneous insulin infusion and multiple daily injections of insulin on glucose variability in older adults with type 2 diabetes
ABSTRACT To determine whether continuous subcutaneous insulin infusion (CSII) or multiple daily injections of insulin (MDI) are associated with improved glycemic variability.
Type 2 diabetic patients ≥60 years of age were randomized to 12 months of CSII (n=53) or MDI (n=54) therapy. Patients were asked to complete monthly eight-point self-monitored glucose profiles (n=78) and continuous glucose monitoring systems (CGMS) for up to 72 h at Months 0, 6, and 12 (n=77). Within-day mean glucose, standard deviation (SD), range, pre- and post-prandial glucose, M value, and mean amplitude of glycemic excursions (MAGE) were calculated from eight-point profiles. Mean glucose, SD, range, area under the curve (AUC) high (>180 mg/dl) and AUC-low (<70 mg/dl) were calculated from CGMS. Mixed model analyses of variance were used to examine the associations between treatment, time, and the study outcomes, adjusting for any effects of sex.
With the use of the eight-point profiles, CSII and MDI groups did not differ with respect to mean glucose, mean pre-prandial and post-prandial glucose, SD, range, M value, or MAGE. With the CGMS data, there were no significant between-group differences in measures of mean glucose, range, SD, AUC-high, or AUC-low. In both treatment groups, all measures improved over time (P<.0001) except for AUC-low (P=.68) which did not change. There were treatment-by-time interactions when considering the CGMS range (P=.04) and AUC-high (P=.001), but no significant differences were found at individual time points.
Glucose variability improved equally with CSII and MDI treatment in older patients with type 2 diabetes.
Article: Diabetes in the ElderlyCanadian Journal of Diabetes 04/2013; 37:S184–S190. DOI:10.1016/j.jcjd.2013.01.045 · 0.46 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: To determine the effectiveness of insulin pump use (CSII) in patients with type 2 diabetes (DM2) who have failed multiple daily injection therapy (MDI)Methods: In this retrospective study, charts of patients with DM2 who were started on CSII after failure of MDI were reviewed. Patients were categorized as primarily manual (fixed) bolus users or calculated (using pump software) bolus users. The change in HbA1c, weight, and basal insulin dose from baseline to 6 months was determined.Results: Fifty-seven patients (20 men and 37 women) ranging in age from 13 to 71 were identified in the study. A significant reduction in HbA1c was observed from 8.75% to 7.69% (p < 0.001). There was an increase in BMI, from a mean of 36.53 to a mean of 37.21. A decrease in basal insulin requirement per kilogram of weight (- 0.10 U/kg) was noted (P=0.03). Seven patients using U-500 insulin in the pump also had a significant decrease in HbA1C of 1.1 % (p < 0.001), along with a 0.071 U/Kg drop in basal insulin requirements (p < 0.001). When comparing calculated bolus users to manual bolus users, there was no difference in HbA1C improvement (P= 0.58).Conclusions: We found that CSII in patients with DM2 who have failed MDI improves glucose control despite a decrease in overall insulin requirements. This includes patients with severe insulin resistance using U-500 insulin. Use of frequent bolus adjustment incorporating carbohydrate counting and current glucose level does not appear to be required for this benefit.Endocrine Practice 09/2012; 19(1):1-17. DOI:10.4158/EP12104.OR · 2.59 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: Hyperglycemia is common and hard to control in surgical patients with diabetes. We retrospectively investigated short-term effects of continuous subcutaneous insulin infusion (CSII) in perioperative patients with diabetes. Patients and Methods: Perioperative patients with diabetes discharged between January 1, 2006 and January 1, 2012 were included. Glucose control and postoperative outcomes were compared between the patients using CSII or non-CSII insulin therapy. Results: We identified 108 pairs of patients matched by propensity and surgical category who were using CSII therapy (CSII group) or non-CSII insulin therapy (control group). The CSII group had significantly lower fasting glucose levels (on the first postoperative day, 9.06±3.09 mmol/L vs. 11.05±4.19 mmol/L; P=0.003) and lower mean glucose levels (on the operation day, 9.93±2.65 mmol/L vs. 12.05±3.86 mmol/L; P=0.001). The CSII group also had a lower incidence of fever (on the first postoperative day, 30.4% vs. 53.2%; P=0.005). Furthermore, patients in the CSII group experienced significantly shorter postoperative intervals for suture removal (P=0.02) and hospital discharge (P=0.03). No significant difference in the total medical expenditure was observed between the two groups (P=0.47). We also made a comparison between the 30 pairs of patients who were using CSII or multiple daily insulin injection therapy but observed no significant difference between these two therapies in glucose control or postoperative outcomes. Conclusions: Compared with non-CSII insulin therapy, even short-term implementation of CSII can improve the postoperative control of glucose, reduce the incidence of postoperative fever, and shorten the time for suture removal and discharge in surgical patients with diabetes.Diabetes Technology & Therapeutics 08/2013; 15(12). DOI:10.1089/dia.2013.0117 · 2.29 Impact Factor