scholarly journals Real-World Efficacy and Safety of Continuous Subcutaneous Insulin Infusion (CSII) Therapy and Comparison of Treatment Satisfaction between CSII and Multiple Daily Injection Therapy

2020 ◽  
Vol 26 (2) ◽  
pp. 85-92
Author(s):  
Inderpal Singh Kochar ◽  
Aashish Sethi ◽  
Smita Ramachandran
Keyword(s):  
Quality Of Life ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Daily Injection ◽  
Subcutaneous Insulin ◽  
Pediatric Endocrinology ◽  
Multiple Daily Injection

<b><i>Objectives:</i></b> Type 1 diabetes mellitus (T1DM) is one of the most common pediatric endocrine diseases. India alone is home to around 97,700 children with T1DM. This paper evaluates the efficacy, safety, and quality of life with continuous subcutaneous insulin infusion (CSII) in patients treated for a protracted time period of 1 year in a retrospective study versus multiple-dose insulin (MDI). <b><i>Methods:</i></b> CSII was offered to patients with poor metabolic control (HbA1c &#x3e;8.5%) on MDI, patients needing flexible timing of meals, or patients with hypoglycemia unawareness/nocturnal hypoglycemia/high blood sugar fluctuations. Continuous blood glucose monitoring (CGM) was done using the Medtronic CGM system gold/iPro 2 in all patients. Data were collected through a questionnaire completed by patients with the help of a pediatric endocrinologist. <b><i>Results:</i></b> A total of 45 patients completed the study evaluation period. The results demonstrated better glycemic control, reduced hypoglycemia on CGM, and no events of diabetic ketoacidosis noted on CSII. The hypoglycemic events were few and nonsevere. The patients in the CSII group reported better quality of life on the Pediatric Quality of Life Inventory 3.2 Diabetic Module diabetes score than the MDI group. <b><i>Conclusions:</i></b> This study is the first of this kind in India in the field of pediatric endocrinology. The clinical outcomes validate the use of CSII as the desirable intensive insulin therapy.

scholarly journals Practical Approach to Using Trend Arrows on Real-Time Continuous Glucose Monitoring System in Type 1 Diabetes Adolescents Living Camp Setting Treated With Multiple Daily Injection or Continuous Subcutaneous Insulin Infusion Insulin Therapy

2020 ◽  
pp. 193229682093480
Author(s):  
Marta Bassi ◽  
Nicola Minuto ◽  
Graziella Fichera ◽  
Clara Rebora ◽  
Alice Parodi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Training Session ◽  
Glucose Monitoring ◽  
Daily Injection ◽  
Subcutaneous Insulin

Background: The aim of the study was to determine the effect of an educational intervention on the use of trend arrows of a real-time continuous glucose monitoring (rt-CGM) to manage daily therapy decisions in a group of adolescents with type 1 diabetes attending a camp. The secondary aim was to evaluate the variations in total daily dose (TDD) of insulin requirement. Methods: Twenty patients (15-17 years) on multiple insulin injections ( n = 8) or continuous subcutaneous insulin infusion ( n = 12) attended a training session at the beginning of the camp to learn our algorithm for the management of therapy depending on trend arrows. TDD, time in range (TIR), time above range (TAR), and time below range (TBR) (in the 24 hours and in the three hours after breakfast) before the training session (run-in) and at the end of the camp (T1) were analyzed. Results: Data showed a reduction of TAR (run-in 42.6%, T1 32.05%, P = .036) and an increase in TIR (run-in 52.9%, T1 62.4%, P = .013). Reduction of TBR (run-in 42.5%, T1 37.5%, P = .05) and improvement in TIR (run-in 49.0%, T1 57.0%, P = .02) were also observed in the post-breakfast period. Data showed a significant reduction in the TDD (run-in 52.02 ± 17.44 U/die, T1 46.49 ± 12.39 U/die, P = .024). Conclusions: Statistically significant improvement of glycemic control and reduction of TTD were observed in all patients regardless of therapy type. The improvement between run-in and T1 demonstrates the importance of patients’ education on the correct use of rt-CGM with simple algorithms for the management of therapy.

scholarly journals HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033059 ◽  
Author(s):  
Emma S Scott ◽  
Rachel T McGrath ◽  
Andrzej S Januszewski ◽  
Daniel Calandro ◽  
Anandwardhan A Hardikar ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Daily Injection ◽  
Subcutaneous Insulin ◽  
Multiple Daily Injection ◽  
Retrospective Audit ◽  
Hba1c Variability

ObjectiveTo determine if continuous subcutaneous insulin infusion (CSII) therapy is associated with lower glycated haemoglobin (HbA1c) variability (long-term glycaemic variability; GV) relative to multiple daily injection (MDI) treatment in adults with type 1 diabetes mellitus (T1DM).DesignRetrospective audit.Setting and participantsClinic records from 506 adults with T1DM from two tertiary Australian hospitals.Outcome measuresLong-term GV was assessed by HbA1c SD and coefficient of variation (CV) in adults on established MDI or CSII therapy, and in a subset changing from MDI to CSII.ResultsAdults (n=506, (164 CSII), 50% women, mean±SD age 38.0±15.3 years, 17.0±13.7 years diabetes, mean HbA1c 7.8%±1.2% (62±13 mmol/mol) on CSII, 8.0%±1.5% (64±16 mmol/mol) on MDI) were followed for 4.1±3.6 years. CSII use was associated with lower GV (HbA1c SD: CSII vs MDI 0.5%±0.41% (6±6 mmol/mol) vs 0.7%±0.7% (9±8 mmol/mol)) and CV: CSII vs MDI 6.7%±4.6% (10±10 mmol/mol) vs 9.3%±7.3% (14±13 mmol/mol), both p<0.001. Fifty-six adults (73% female, age 36±13 years, 16±13 years diabetes, HbA1c 7.8%±0.8% (62±9 mmol/mol)) transitioned from MDI to CSII. Mean HbA1c fell by 0.4%. GV from 1 year post-CSII commencement decreased significantly, HbA1c SD pre-CSII versus post-CSII 0.7%±0.5% (8±5 mmol/mol) vs 0.4%±0.4% (5±4 mmol/mol); p<0.001, and HbA1c CV 9.2%±5.5% (13±8 mmol/mol) vs 6.1%±3.9% (9±5 mmol/mol); p<0.001.ConclusionsIn clinical practice with T1DM adults relative to MDI, CSII therapy is associated with lower HbA1c GV.

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