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Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study
- Source :
- Medicina Clínica. 146:239-246
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL).A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data.After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p0.03).Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes.
- Subjects :
- Adult
Blood Glucose
Male
medicine.medical_specialty
Adolescent
Injections, Subcutaneous
medicine.medical_treatment
Insulin Glargine
030209 endocrinology & metabolism
Infusions, Subcutaneous
Drug Administration Schedule
Diabetes Complications
Young Adult
03 medical and health sciences
0302 clinical medicine
Quality of life
Internal medicine
Diabetes mellitus
Humans
Hypoglycemic Agents
Medicine
030212 general & internal medicine
Meals
Aged
Glycated Hemoglobin
Type 1 diabetes
Insulin Lispro
integumentary system
business.industry
Blood Glucose Self-Monitoring
Insulin
Parallel study
General Medicine
Middle Aged
medicine.disease
Hypoglycemia
Ketoacidosis
Regimen
Diabetes Mellitus, Type 1
Treatment Outcome
Endocrinology
Basal (medicine)
Anesthesia
Quality of Life
Female
business
Subjects
Details
- ISSN :
- 00257753
- Volume :
- 146
- Database :
- OpenAIRE
- Journal :
- Medicina Clínica
- Accession number :
- edsair.doi.dedup.....593404e0037573747ac15fc9a6d910de