Effectiveness of Intensive Insulin Therapy by Multiple Daily Injections and Continuous Subcutaneous Infusion: A Comparison Study in Type 2 Diabetes with Conventional Insulin Regimen Failure

Abstract

Objective: To compare the effectiveness of two intensified insulin regimens, i.e., pump delivery versus multiple daily injections in patients with type 2 diabetes not optimally controlled with conventional insulin therapy.

Research design and methods: Seventeen type 2 diabetes patients uncontrolled by two daily injections of regular plus NPH were randomly assigned in a cross-over fashion to either three daily injections of lispro plus NPH or pump device delivering lispro. HbA1c, 6 points capillary blood glucose, 24-hour continuous glucose monitoring system tracings and global satisfaction score were evaluated at the end of each 12-week treatment period.

Results: HbA1c decreased from 9.0±1.6% to 8.6±1.6% with multiple injections and 7.7±0.8% with pump device (p<0.03). Capillary blood glucose was lowered at all time-points with pump, but only at morning with multiple injections (p<0.01). Compared to conventional therapy, pump reduced hyperglycemic area under curve by 73% (p<0.01), but multiple injections by only 32% (p=0.08). Rate of hypoglycemia was not increased and patient's satisfaction was comparable with both intensive treatments.

Conclusions: Pump therapy provides a better metabolic control than injection regimens, and seems to be safe and convenient in patients with type 2 diabetes who fail to respond to conventional insulin therapy.

Key words

type 2 diabetes - continuous subcutaneous insulin infusion - Humalog Mix50 - continuous glucose monitoring system

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