Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes

Abstract

OBJECTIVE -Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA 1c and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings.RESULTS -HbA 1c values decreased similarly for both groups from baseline (8.2 Ϯ 1.37% for CSII, 8.0 Ϯ 1.08% for MDI) to end of study (7.6 Ϯ 1.22% for CSII, 7.5 Ϯ 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 Ϯ 48 vs. 192 Ϯ 65 mg/dl for CSII and MDI, respectively; P ϭ 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups.CONCLUSIONS -Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes. Patients with type 2 diabetes can be trained as outpatients to use CSII and prefer CSII to injections, indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes.

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

“…For studies with crossover design the SMD in glycated haemoglobin was −0.4 (95% CI: −0.68, −0.07; I 2 =52%), corresponding to −0.4% in original units. For Patients with type 2 diabetes mellitus In both trials [44,45] no significant differences in HbA 1c between the two treatment groups were found at the end of the study (Table 1).…”

“…All in all, severe hypoglycaemic episodes were rare. In one study [45], there were no severe hypoglycaemic episodes and in the other study [44] three patients in the CSII compared with six patients in the MDI group experienced severe hypoglycaemia. The event rate per patient-year was not significantly different, although it tended towards a reduction in favour of CSII treatment (CSII, 0.1 vs MDI, 0.2 events per patient-year).…”

“…Raskin et al [45] showed a slight reduction in insulin requirements in the CSII group compared with the MDI group, while Herman et al [44] did not find any difference at all.…”

“…In the end, 33 publications with usable information were included in our systematic review. Of these, 17 studies (27 publications ) included mainly adult type 1 diabetic patients, three trials (four publications [40][41][42][43]) only children of up to 18 years and two studies (two publications [44,45]) examined patients with type 2 diabetes mellitus only.…”

“…Patients with type 2 diabetes mellitus Both studies had an open-label parallel study design [44,45] and 234 patients took part in the randomised controlled trials. The study periods were 24 and 52 weeks, respectively.…”