Effects of Insulin Therapy with Continuous Subcutaneous Insulin Infusion (CSII) in Diabetic Patients: Comparison with Multi-daily Insulin Injections Therapy (MDI)

Derosa, Giuseppe; Maffioli, Pamela; D’Angelo, Angela; Salvadeo, Sibilla A T; Ferrari, Ilaria; Fogari, Elena; Mereu, Roberto; Gravina, Alessia; Palumbo, Ilaria; Randazzo, Sabrina; Cicero, Arrigo F G

doi:10.1507/endocrj.k08e-330

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…It is still a matter of discussion whether or not the additional costs related to CSII are justified from a medical point of view, i.e. whether CSII is superior to MDI in terms of metabolic control and prevention of glycaemic excursions . Instead of individual glucose measurements several hours apart, CGM appears to be ideally suited to detect “automatically” otherwise unheralded extremes and fluctuations of glucose concentrations during a reasonable period of times, i.e.…”

Section: Discussionmentioning

confidence: 99%

Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross‐sectional cohort study

Schreiver

Jacoby

Watzer

et al. 2013

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 99%

Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross‐sectional cohort study

Schreiver

Jacoby

Watzer

et al. 2013

Clinical Endocrinology

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“…[47][48][49][50] Number of participants ranged from 20 to 66 adults per arm in the included studies. Only 1 study included participants 60 years of age or older.…”

Section: Adults With T2dmmentioning

confidence: 99%

“…[48][49][50] Additionally, the evaluation of hypoglycemia revealed no difference between CSII and MDI in mild hypoglycemia (moderate strength of evidence; combined relative risk [RR] = 0.90; 95% CI, 0.78-1.03; P = 0.129) or severe hypoglycemia (low strength of evidence; RR = 0.76; 95% CI, 0.26-2.19; P = 0.61). 47,49 In a single study, nocturnal hypoglycemia was less common in the CSII arm compared with the MDI arm (insufficient strength of evidence).…”

Section: Adults With T2dmmentioning

confidence: 99%

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

Golden¹,

Sapir²

2012

JMCP

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, before training in internal medicine and endocrinology and metabolism at the Johns Hopkins Hospital. During her fellowship in endocrinology, she received a master of health science degree in clinical epidemiology from the Johns Hopkins University Bloomberg School of Public Health. Her primary research interest centers around identifying endocrine risk factors associated with the development of diabetes and cardiovascular disease through the incorporation of measures of hormonal function into the design of clinical trials of cardiovascular risk modification, observational studies of incident cardiovascular disease and diabetes, and studies evaluating diabetic complications. Her current research focuses on studying the neuroendocrine response to chronic psychological stress as a risk factor for diabetes and cardiovascular disease. Dr Supplement Policy Statement Standards for Supplements to the Journal of Managed Care PharmacySupplements to the Journal of Managed Care Pharmacy are intended to support medical education and research in areas of clinical practice, health care quality improvement, or efficient administration and delivery of health benefits. The following standards are applied to all JMCP supplements to ensure quality and assist readers in evaluating potential bias and determining alternate explanations for findings and results. 1. Disclose the principal sources of funding in a manner that permits easy recognition by the reader. 2. Disclose the existence of all potential conflicts of interest among supplement contributors, including financial or personal bias. 3. Describe all drugs by generic name unless the use of the brand name is necessary to reduce the opportunity for confusion among readers. 4. Identify any off-label (unapproved) use by drug name and specific off-label indication. 5. Strive to report subjects of current interest to managed care pharmacists and other managed care professionals. S15 References Target AudiencesThis CME activity is designed to meet the educational needs of physicians, pharmacists, nurses, and case managers involved in the management and care of patients with diabetes. Learning ObjectivesBased on the findings from the Agency for Healthcare Research and Quality' s (AHRQ) comparative effectiveness review of insulin delivery and glucose-monitoring modalities for diabetes, participants should be able to: 1. Compare the benefits of insulin delivery systems in improving clinical outcomes, glycemic control, hypoglycemia, and quality of life in diabetic patients receiving intensive insulin therapy 2. Evaluate the differential effect of glucose-monitoring approaches on the process measures and intermediate and clinical outcomes in diabetic patients receiving intensive insulin therapy 3. Apply the AHRQ findings to guide effective, patient-centered clinical decisions Funding There is no fee for this CME/CE activity. This learning activity was prepared and funded under contract HHSA290201000006G from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Hea...

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“…Continuous subcutaneous insulin infusion (CSII) therapy in people with type 1 diabetes is associated with improved PPG 9 and overall glycemic control, as well as decreased risk of hypoglycemia, 10,11 and improved quality of life 12 and user convenience, compared with multiple daily subcutaneous (s.c.) injections. 10,13 Improvements in the compatibility of RAIAs versus buffered regular human insulin 14 and developments in sensor and pump technology have contributed to increased use of CSII.…”

Section: Introductionmentioning

confidence: 99%

Improved Postprandial Glycemic Control with Faster-Acting Insulin Aspart in Patients with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion

Bode

Johnson

Hyveled

et al. 2017

Diabetes Technology & Therapeutics

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Background: Faster aspart is insulin aspart (IAsp) in a new formulation, which in continuous subcutaneous insulin infusion (CSII) in subjects with type 1 diabetes has shown a faster onset and offset of glucose-lowering effect than IAsp.Methods: This double-blind, randomized, crossover active-controlled trial compared 2-h postprandial plasma glucose (PPG) response, following 2 weeks of CSII with faster aspart or IAsp. Primary endpoint: mean change in PPG 2 h after a standardized meal test (ΔPGav,0–2h). Subjects (n = 43) had masked continuous glucose monitoring (CGM) throughout.Results: Faster aspart provided a statistically significantly greater glucose-lowering effect following the meal versus IAsp: ΔPGav,0–2h: 3.03 mmol/L versus 4.02 mmol/L (54.68 mg/dL vs. 72.52 mg/dL); estimated treatment difference (ETD) [95% CI]: −0.99 mmol/L [–1.95; −0.03] (−17.84 mg/dL [–35.21; −0.46]; P = 0.044). One hour postmeal, PG levels were −1.64 mmol/L (−29.47 mg/dL) lower with faster aspart versus IAsp (P = 0.006). Interstitial glucose (IG) profiles supported these findings; the largest differences were observed at breakfast: 9.08 versus 9.56 mmol/L (163.57 vs. 172.19 mg/dL; ETD [95% CI]: −0.48 mmol/L [–0.97; 0.01]; −8.62 mg/dL [–17.49; 0.24]; P = 0.057). Duration of low IG levels (≤3.9 mmol/L [70 mg/dL] per 24 h) was statistically significantly shorter for faster aspart versus IAsp (2.03 h vs. 2.45 h; ETD [95% CI]: −0.42 [–0.72; −0.11]; P = 0.008). No unexpected safety findings were observed.Conclusions: CSII delivery of faster aspart had a greater glucose-lowering effect than IAsp after a meal test. CGM results recorded throughout all meals supported this finding, with less time spent with low IG levels.

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Effects of Insulin Therapy with Continuous Subcutaneous Insulin Infusion (CSII) in Diabetic Patients: Comparison with Multi-daily Insulin Injections Therapy (MDI)

Cited by 11 publications

References 25 publications

Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross‐sectional cohort study

Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross‐sectional cohort study

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

Improved Postprandial Glycemic Control with Faster-Acting Insulin Aspart in Patients with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion

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