What happens in the long‐term to the intensively treated IDDM patient? A four year follow‐up

Abstract

AbstractA four year follow‐up of treatment with continuous subcutaneous insulin infusion (CSII) or multiple injections (MI) in not‐highly selected insulin‐dependent diabetic patients is presented. Forty patients (CSII 25; MI 15) were followed for 51.0 months from the start of intensified insulin therapy. Eleven patients (44%) changed from CSII to MI; none changed in the reverse direction or to any other regimen. The initial improvement in HbA1c was lost both in the CSII, MI and change‐over groups. On CSII three patients experienced five subcutaneous abscesses at infusion sites, and two were hospitalised with diabetic ketoacidosis. Hypoglycaemia requiring assistance was equally common on the two treatment modalities. The initial weight gain tended to continue.We conclude that insulin‐dependent diabetic patients clearly prefer Intensified Insulin therapy, especially MI, for long‐term treatment. How ever, the initial improvement in glycaemic control was not maintained in the long‐term in these patients who were not highly selected. Subcutaneous abscesses at infusion sites and diabetic ketoacidosis requiring hospitalisation occurred exclusively on CSII. These results have important implications for the long‐term treatment of those with insulin‐dependent diabetes.