Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years

Linkeschova, R.; Raoul, M.; Bott, U.; Berger, Michael; Spraul, Maximilian

doi:10.1046/j.1464-5491.2002.00713.x

Cited by 149 publications

(122 citation statements)

References 25 publications

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“…It must be noted, however, that many of the studies included in these meta-analyses and for calculating cost-effectiveness were published several years before the introduction of currently available pumps, and, more importantly, these models have never been validated against real long-term prospective controlled trials, so their value is questionable. Furthermore, more recent studies show that CSII therapy is associated with fewer severe hypoglycemic events (A: 89; C: [92][93][94]. Even if these models were accurate, what is cost-effective in adults may not be cost-effective in children given the additional health team interventions required for children and their families.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Use of Insulin Pump Therapy in the Pediatric Age-Group

et al. 2007

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Section: Cost-effectivenessmentioning

confidence: 99%

Use of Insulin Pump Therapy in the Pediatric Age-Group

et al. 2007

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“…Muitos estudos confirmam a diminuição da hipoglicemia grave com a infusão contínua de insulina subcutânea comparada à terapia insulínica por injeções, muitas vezes alcançando reduções até de 70% (18)(19)(20)(21). Vale ressaltar que os valores encontrados nestes estudos diferem muito, principalmente por nem sempre se definir corretamente hipoglicemia grave, isto é, a necessidade de ajuda de terceiros e/ou uso de …”

Section: Discussão E Conclusõesunclassified

Comparação entre a bomba de infusão de insulina subcutânea e o esquema de múltiplas doses de insulina em adolescentes com diabetes melito do tipo 1 da rede pública de saúde na abordagem da hipoglicemia grave

Gabbay

Dib

2007

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Avaliação comparativa da freqüência de hipoglicemia severa após mudança da terapia com múltiplas doses de insulina (MDI) para bomba de insulina subcutânea (BIISC). Pacientes e Métodos: Sete pacientes DM1, idade Mi = 14 anos e tempo médio de diabetes de 8 anos, comparados de acordo com a incidência de hipoglicemia, a dose total de insulina (U/Kg/d), IMC (Kg/m 2 ) e HbA1c (vn: 3,5-6,7%) 1 ano antes e 1 ano após a transferência de terapêutica. Houve redução significativa dos episódios de hipoglicemia severa (1,3 episódio/paciente/ano para zero episódio/paciente/ano; p = 0,04), na dose total diária de insulina (1,33 ± 0,26 U/Kg/dia para 0,87 ± 0,17 U/kg/dia; p = 0,04) e na HbA1c (8,7 ± 0,7% para 7,8 ± 0,9%; p = 0,05 com BIISC). Concluímos que a BIISC é eficaz e segura na redução de hipoglicemia severa em um subgrupo de pacientes DM1 com MDI. Entretanto, os resultados obtidos precisam ser reproduzidos em centros semelhantes e estudos de custo são necessários para que a sua viabilidade seja confirmada e aplicada nos sistemas públicos de saúde, que correspondem à maioria no nosso país. ABSTRACT Comparison Between Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Regimens in Adolescent with Type 1Diabetes from a Public Health Care System Approach to Severe Hypoglycemia. Objective: We compared the incidence of severe hypoglycemia episodes with therapy with multiple doses of insulin (MDI) and after changing to pump (CSII). Patients and methods: 7 T1DM patients with 14 years median and median duration of diabetes of 8 years. We analyzed insulin requirement (U/kg/day), BMI (Kg/m 2 ), HbA1c (normal range: 3.5-6.7%) one year before and one year after changing therapy. The severe hypoglycemia episodes decreased from 1.3 to 0 episodes/patient/year; p = 0.00). The insulin requirement decreased from 1.33 ± 0.26 U/Kg/day to 0.87 ± 0.17 U/kg/day; p = 0.04 and HbA1c decreased from 8.7 ± 0.7% to 7.8 ± 0.9%; p = 0.05. Conclusion: CSII is efficient in decreasing severe hypoglycemia in a subgroup of T1DM using MDI also in Public Health Care System (PHCS) conditions. However, these finding should be reproduced by other Diabetes Care centers and cost studies are necessary to confirm the viability and possibility of this therapy, when necessary, to T1DM patients, which correspond to the majority of these individuals in our country, seeing in the PHCS.

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“…Many subsequent studies have confirmed the hypoglycemia-reducing effect of insulin pumps (2,(11)(12)(13), with typical reductions in frequency of severe hypoglycemia of ϳ70% compared with MDI.…”

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confidence: 90%