Time in ranges and glucose variability in patients with type 1 diabetes on continuous subcutaneous insulin infusion and multiple daily injections

Abstract

Background and aim: In this study we aimed to compare the metrics of time in ranges (TIRs) and indices of glucose variability (GV) in patients with type 1 diabetes (T1D) on continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in the hospital settings. Materials and Methods: Four hundred hospitalized patients with T1D were examined, including 111 on CSII and 289 on MDI. The TIR, time above range (TAR), time below range (TBR) and a panel of GV parameters were derived from real-time continuous glucose monitoring (CGM) data. Results: Subjects on CSII, as compared to those on MDI, demonstrated significantly decreased day-time and nocturnal mean glucose and TAR (p<0.05) and increased TIR and TBR (p<0.05). Patients on CSII showed lower Standard Deviation, Coefficient of Variation, Continuous Overlapping Net Glycemic Action, Lability Index, J-index, High Blood Glucose Index, Mean Amplitude of Glucose Excursions, and Mean Absolute Glucose (all p<0.05), as well as glycated hemoglobin A1c levels (p=0.001). The Low Blood Glucose Index (p=0.02), number and duration of level 1 hypoglycemia (3.8-3.0 mmol/L, all p<0.01) were higher in CSII group. The mean number of hypoglycemic episodes and duration of the longest episode of clinically significant hypoglycemia (<3 mmol/L) did not differ between the groups. Conclusions: Patients with TID on CSII have better TIR and TAR values and lower GV compared with those on MDI, demonstrating no differences in the prevalence of clinically important hypoglycemia.