Comparison of continuous subcutaneous insulin infusion and insulin glargine-based multiple daily insulin aspart injections with preferential adjustment of basal insulin in patients with type 2 diabetes.

YUE-LI WANG,GUAN-QI GAO,WEN-XIA LI,QING-YU DONG,WEN-HUA DU,CUI-GE LIANG,XUE-YUAN HENG,XIAO-MENG LIU

doi:10.3892/etm.2014.1866

Abstract

The purpose of this study was to evaluate and compare multiple daily injection (MDI) therapy of bolus insulin aspart and basal insulin glargine with continuous subcutaneous insulin infusion (CSII) with aspart in patients with type 2 diabetes mellitus (T2DM). It was assessed whether MDI was capable of controlling glycemic index with a higher efficacy than CSII by preferential adjustment of basal insulin with a lower total daily insulin dosage in T2DM. Two hundred patients with T2DM were enrolled in the study and randomly assigned to CSII (n=100) and MDI (n=100; aspart immediately prior to each meal and glargine at bedtime) groups for 12 weeks of therapy. During the last week of each treatment period, the subjects wore a continuous glucose monitoring system for 2–3 days. The dosage of basal insulin was preferentially adjusted to control prior-meal blood glucose levels, and the characteristics of insulin dosage were analyzed. No statistically significant differences were observed between the two groups in hemoglobin A1c (HbA1c), which dropped from 10–11% prior to therapy to 7–7.5% after 12 weeks. After 12 weeks, good glycemic level control was achieved in all patients in the MDI and CSII groups. A statistically significant difference in the dose of insulin between the CSII and MDI groups was observed (P<0.001). In conclusion, no significant differences were found between the two therapies in the incidence of hypoglycemia and HbA1c for the 12 weeks. The basal insulin dosage was significantly decreased in the MDI group compared with that in the CSII group, but the CSII group was superior to MDI group in decreasing fasting blood glucose and shortening the time required for hypoglycemia to meet the targeted level.

Highlights

Continuous subcutaneous insulin infusion (CSII) therapy with an external pump and multiple daily injection (MDI) therapy are two of the currently selected methods of insulin treatment for diabetes
No statistically significant differences were observed between the CSII and MDI groups in gender, age, hemoglobin A1c (HbA1c), fasting serum C‐peptide, body mass index, fasting blood glucose (FBG) or other clinical data (P>0.05) (Table I)
Descriptive data are expressed as the mean ± standard deviation. aP>0.05 versus MDI group

Summary

Introduction

Continuous subcutaneous insulin infusion (CSII) therapy with an external pump and multiple daily injection (MDI) therapy are two of the currently selected methods of insulin treatment for diabetes. MDI therapy for diabetes requires bolus injections of rapid or short‐acting insulin prior to each meal and a long‐acting insulin injection once or twice per day for basal insulin coverage. Long‐acting insulin, such as insulin glargine, is suitable as a basal insulin therapy in diabetes [3,4]. CSII therapy produces a higher efficacy than MDI and improvements in insulin pump technology have resulted in an increase in patient preference [5,6,7,8,9,10]. Occasionally patients may have to temporarily discontinue CSII therapy due to skin problems, pump malfunction or physical activity. It has been shown that MDI therapy is at least equivalent in its action to CSII [10]

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Results

Conclusion