Insulin Pump Therapy with Simple Scheme in Insufficiently Controlled Patients with Type 2 Diabetes on Intensive Injection Therapy—A Real-Life Study

Abstract

Background and Aims: Many patients with type 2 diabetes mellitus on intensive insulin injection therapy (MDI) do not reach adequate glycemic control. A randomized controlled trial has shown that continuous subcutaneous insulin infusion (CSII) using a simple scheme with one basal rate, improves glycemic control (Lancet 2014; 384: 1265-72). We studied effectiveness of this scheme in a real life setting. Materials and Methods: Patients with type 2 diabetes with HbA1c ≥ 64 mmol/mol on MDI with insulin requirement between 0.7 and 2.2 U/day were eligible. Hourly basal rate was 50% of the total daily dose (TDD) divided by 24; 50% of TDD was divided equally between three meals. Trial duration 6 months. Results: Sixty-seven patients participated. Mean age: 61.3±0.9 years, 42% female; duration of disease: 16.0±7.6 years; weight: 10.7.4±21.9 kg; BMI: 35.8±6.9 kg/m2, baseline TDD: 135.5±62.3 U/day. Mean HbA1c fell from 80.1 ± 15.2 to 62.4 ±10.0 mmol/mol (p<0.001); mean change in HbA1c -17.7±2.1 mmol/mol. After exclusion 3 outliers (ΔHbA1c >-50 mmol/mol), the results were comparable: HbA1c fell from 78.0±11.8 to 63.0 ±9.7 mmol/mol (p<0.001); mean change -15.0±1.5 mmol/mol. Total cholesterol decreased slightly (4.33±0.13 to 4.21±0.13 mmol/l, p<0.05); no changes in other lipid parameters or blood pressure. Body weight increased from 106.2±19.5 to 109.3±20.61 kg (p<0.001). Conclusion: This real-life study shows that introducing CSII with simple insulin schema in patients with insufficiently-controlled type 2 diabetes on MDI, leads to major improvement of glycemic control, at the expense of some weight gain. This approach provides a worthwhile alternative in patient with poorly-controlled DM2 and considerable insulin resistance. Nutritional counselling deserves attention to diminish weight gain. Disclosure H.W. de Valk: None.