Continuous Subcutaneous Insulin Infusion Initiation Research Articles

Glycemic, auxologic, and seasonal aspects of continuous subcutaneous insulin infusion therapy in children and young adults with type 1 diabetes.

Use of continuous subcutaneous insulin infusion (CSII) therapy has increased among patients with type 1 diabetes. This study was performed: (1) to evaluate the effect of CSII on diabetes control in children and young adults, (2) to detect effects of CSII on weight, body mass index (BMI), and insulin requirements, (3) to investigate seasonal variation in diabetes control during CSII therapy, and (4) to investigate the effect of season of initiation of CSII on glycemic control. Thirty-nine patients, ranging in age from 10.1 to 20.5 years, with type 1 diabetes were studied. Quarterly data over 12 months preceding and following CSII initiation were obtained retrospectively. Variables were compared over similar time periods. SAS was used for descriptive and paired t test analysis. (1) Mean blood glucose level was significantly lower at 3 months but not different from baseline at 6, 9, and 12 months post-CSII. (2) Glycosylated hemoglobin (HbA1c) was significantly lower at 3 and 6 months but not at 9 and 12 months post-CSII. (3) There was no significant difference in the frequency of hypoglycemia or hyperglycemia at any of the time periods studied. (4) There was an initial but unsustained decrease in daily weight-adjusted insulin requirements after CSII. (5) There was a rapid, sustained increase in weight and BMI following CSII in females. (6) Frequency of ketoacidosis decreased in two patients. (7) There was no seasonal variation in weight change, HbA1c, or frequency of measured hypoglycemic episodes with CSII. (8) There was some effect of the season of initiation of CSII therapy on glycemic control. Thus, (1) CSII glycemic benefits may not be sustained, (2) weight gain is a significant effect of CSII in adolescent females, and (3) CSII may be a means of decreasing ketoacidosis episodes, and eliminating seasonal variability in diabetes control.

Assessment of Therapy with Continuous Subcutaneous Insulin Infusion in an Academic Diabetes Clinic

To assess the results of continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus, especially relative to glycemic control and rate of discontinuation of insulin pump therapy. A retrospective review of the medical records of 107 patients with type 1 diabetes who were receiving CSII at the Diabetes Care Center at the University of Washington Medical Center was performed to evaluate clinical outcomes. All patients considering CSII therapy participated in a class to learn the details of insulin pump treatment. The mean age of our patient population was 36.0 +/- 10.4 years (mean value +/- standard deviation). The mean duration of diabetes at the initiation of insulin pump therapy was 17.0 +/- 9.1 years. The mean duration of CSII use was 36.1 +/- 25.5 months (median, 26.2 months). Insulin lispro was used by 89.7% of the patients. Six patients (5.6%) discontinued CSII therapy after a mean of 19.1 +/- 14.7 months for a variety of reasons. Despite no significant difference in home blood glucose monitoring (number of tests per day) before initiation of CSII, mean hemoglobin A1c levels decreased from 7.6% to 7.1% (P<0.0001), and the occurrence of severe hypoglycemic episodes decreased 73.8% (P = 0.0003). In our academic diabetes clinic with a formal insulin pump program, we noted a significant improvement in hemoglobin A1c values, a significant reduction in the frequency of severe hypoglycemic episodes, and a low rate of discontinuation of CSII. CSII therapy, when provided in conjunction with a standard educational program, should continue to be an important treatment option in appropriately selected patients with type 1 diabetes.

Protocol for outpatient screening and initiation of continuous subcutaneous insulin infusion therapy: impact on cost and quality.

The purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 1/2 years. One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2 1/2 years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin A1C (A1C) were measured and compared. The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). A1C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections. A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2 1/2 years.

Life with continuous subcutaneous insulin infusion (CSII) therapy: child and parental perspectives and predictors of metabolic control.

The purpose of this study was twofold (i): to evaluate metabolic control in patients receiving CSII therapy in a routine pediatric diabetes clinic by describing reasons for initiating therapy and daily management issues, including needle fear; and (ii) to assess the change in parental involvement and anxiety once their child initiated CSII therapy. The study included 52 subjects (aged 7.6-23.6 yr) from a general pediatric diabetes clinic. Management issues were defined as diet, exercise, home blood glucose monitoring (HBGM) frequency, and self/staff assessment of needle fear. Characteristics were analyzed both according to a 0.5% change in HbA1c status (decreased vs. stable vs. increased) compared with pre-CSII therapy, and final HbA1c achieved (< or = 8.1 vs. > 8.1%). The primary recommendation source for CSII use was most often the physician/diabetes team (48.1%), followed by a combination of the former with a personal referral source (32.7%). The most common reason (71.2%) for CSII initiation was a combination of wanting to achieve better metabolic control, dislike of insulin injections, and/or increased flexibility in daily living. Over one-quarter (26.9%) of subjects were identified as being needle-fearful, and this characteristic was predictive of final metabolic control (3/25 subjects </= 8.1% vs. 11/27 subjects > 8.1%, p = 0.03). On CSII therapy, dietary carbohydrate consistency was highly variable, and most subjects (65.3%) exclusively used an insulin to carbohydrate ratio for insulin bolus dosage calculation. The most common adjustment strategy (63.5%) for exercise was a combination of decreasing the insulin basal rate, disconnecting the pump, and/or eating extra carbohydrates. For the total cohort, the frequency of HBGM significantly increased on CSII therapy (4.31-4.85 tests/day, p = 0.02). Females did not have a significant change in HBGM frequency, while the youngest subjects had the highest HBGM frequency. Parental involvement and anxiety primarily stayed the same or decreased, regardless of the child's age (< or = 18 vs. > 18 yr) or metabolic control. Analyses of the various characteristics identified only needle fearfulness as being predictive of poor metabolic control. Interestingly, poor control with CSII therapy did not result in a significant increase in parental involvement and/or anxiety.

Implementation of continuous subcutaneous insulin infusion therapy: an overview.

Continuous subcutaneous insulin infusion (CSII) devices are designed to provide physiologic insulinemia. Not only do they offer increased life-style flexi bility, they also make it possible to achieve near-normal levels of glycemia. These devices are programmed to deliver a continuous "basal" infusion. Preprandial bolus doses of insulin are given to prevent postprandial hyperglycemia. Careful patient screening and selection are necessary to ensure a successful outcome. Patients must have the maturity, technical ability, motivation, and financial resources needed to utilize CSII therapy. Initiation of CSII can be accomplished in an outpatient or inpatient setting, but both require a comprehensive educational curriculum.

Surveillance in Florida of Continuous Subcutaneous Insulin Infusion Use in Cohort

Because of concerns about safety and expense associated with continuous subcutaneous insulin infusion (CSII), all people who had used CSII as of July 1982 were identified. Annual follow-up has resulted in data for up to 61 mo. Of the 92 nonpregnant registrees, 31 were less than 20 yr old, 36 were 20-29, and 25 were 30 yr or older. Two deaths occurred in 1780 person-months of pump use. The cumulative proportion on the pump (CPOP) or actuarial CSII continuance proportion was 11%. There was no significant difference between sexes or between ages for men, but despite eliminating pregnant women, those greater than or equal to 30 yr old had a CPOP of 0.22, compared with 0.11 for those less than 30 yr (P = .03). Continuance curves were no different for those beginning CSII with or without complications or for those with or without good glucose control. Those who began at patient request did have better CPOP than those who began at physician request (P = .05). Physician perception of clinical, mechanical, or psychosocial problems while on the pump was not predictor of continuance curves as measured by CPOP. Of the 17 physicians queried at the latest update, 9 physicians have 16 current CSII users; these 9 have only 14% of their patients in the original cohort currently on CSII. This is compared with the 3 physicians who have 34 current users and 60% of their original cohort on CSII. Four physicians no longer use CSII. Devices for CSII cost +131/person-month of use.(ABSTRACT TRUNCATED AT 250 WORDS)