Affiliation:
1. Atlanta Diabetes Associates Atlanta, Georgia
Abstract
OBJECTIVE
To compare the incidence of severe hypoglycemia in patients crossed over from multiple daily injections (MDIs) of insulin to continuous subcutaneous insulin infusion (CSII).
RESEARCH DESIGN AND METHODS
From a population of 255 patients using CSII, all patients who met the following selection criteria were included in the present study: 1) a minimum of 12 months on intensive therapy with MDIs before switching to CSII, and 2) a minimum of 12 months on CSII after crossover. Glycemic control and adverse event rates for the 1-year MDI control period were compared with those for the CSII therapy period.
RESULTS
The incidence of severe hypoglycemia during MDI therapy declined from 138 to 22 events per 100 patient-years during the 1st year of CSII (P < 0.0001) and remained significantly lower in years 2, 3, and 4 on CSII (26, 39, and 36, respectively). HbA1c levels did not change significantly between the MDI phase and any year on CSII. However, in the subgroup of patients who had pre-CSII HbA1c levels of ≥8.0%, the change to CSII was associated with a significant reduction in HbA1c from baseline to year 1 (8.9 ± 0.8 vs. 8.1 ± 1.0%, P = 0.0004). The difference in diabetic ketoacidosis rates between the MDI year (14.6 events per 100 patientyears) and the CSII period (7.2 events per 100 patient-years) was not statistically significant.
CONCLUSIONS
CSII therapy was associated with a marked and sustained reduction in the rate of severe hypoglycemia without adversely affecting the level of glycemic control attained during MDI therapy. The more reproducible and flexible insulin delivery afforded by CSII was considered to be the major factor contributing to the improvement in severe hypoglycemia rates.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
224 articles.
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