Journal of the Chinese Medical Association
Volume 71, Issue 7 , Pages 353-356, July 2008

Metabolic Control with Insulin Pump Therapy: Preliminary Experience

  • Shang-Ren Hsu

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Shi-Dou Lin

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Shi-Dou Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, 135, Nan-Shiao Street, Changhua 500, Taiwan, R.O.C
    • ,
  • Shih-Te Tu

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Pei-Yung Liao

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Shih-Li Su

      Affiliations

    • Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Su-Lan Lin

      Affiliations

    • Diabetes Center, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Ya-Yu Tseng

      Affiliations

    • Diabetes Center, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.
    • ,
  • Pei-Wen Huang

      Affiliations

    • Diabetes Center, Changhua Christian Hospital, Changhua, Taiwan, R.O.C.

Received 2 January 2008; accepted 2 July 2008.

Article Outline

Background

The benefits of insulin pump therapy on the metabolic control of both type 1 and type 2 diabetes have been reported. Such reports have prompted our interest to investigate the long-term metabolic effects of insulin pump therapy at our institution.

Methods

We retrospectively analyzed the management of type 1 and type 2 diabetic patients who began extended insulin pump therapy at Changhua Christian Hospital between November 2004 and October 2007. One-way ANOVA and post hoc analysis were used to compare baseline glycosylated hemoglobin (HbA1C) values with subsequent values.

Results

We studied 12 patients who were on continuous subcutaneous insulin infusion (CSII) therapy at the time of data collection. Mean duration of CSII therapy was 2.3 years. A reduction in HbA1C was found after administering CSII, which was sustained after 1, 2 and 3 years of therapy (7.0%, 6.7% and 6.6%, respectively), with statistical significance (p <0.05). No incidence of severe hypoglycemia or diabetic ketoacidosis occurred during the treatment period.

Conclusion

Our preliminary experience demonstrated the effectiveness of insulin pump therapy for both type 1 and type 2 diabetic patients. The reduction in their HbA1C values was both statistically and clinically significant. This treatment should be considered for patients poorly controlled by subcutaneous insulin injection therapy.

Key Words:  continuous subcutaneous insulin infusion (CSII) , diabetic ketoacidosis , glycosylated hemoglobin A (HbA1C)

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Diabetes Control and Complications Trial Research Group  . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;329:977–986
  2. UK Prospective Diabetes Study (UKPDS) Group  . Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS33) . Lancet . 1998;352:837–853
  3. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, et al  Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study . Diabetes Res Clin Pract . 1995;28:103–117
  4. Pickup J , Keen H . Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes . Diabetes Care . 2002;25:593–598
  5. Nielsen S , Kain D , Szudzik E , Dhindsa S , Garg R , Dandona P . Use of continuous subcutaneous insulin infusion pump in patients with type 2 diabetes mellitus . Diabetes Educ . 2005;31:843–848
  6. Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, et al  Insulin pump therapy vs. multiple daily injections in obese type 2 diabetic patients . Diabet Med . 2005;22:1037–1046
  7. Bode BW , Tamborlane WV , Davidson PC . Insulin pump therapy in the 21st century: strategies for successful use in adults, adolescents, and children with diabetes . Postgrad Med . 2002;111:69–77
  8. Bode BW , Sabbah HT , Gross TM , Fredrickson LP , Davidson PC . Diabetes management in the new millennium using insulin pump therapy . Diabetes Metab Res Rev . 2002;18(Suppl 1):S14–S20
  9. Plotnick LP , Clark LM , Brancati FL , Erlinger T . Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes . Diabetes Care . 2003;26:1142–1146
  10. Ahern JA, Boland EA, Doane R, Ahern JJ, Rose P, Vincent M, et al. Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower HbA1C levels across all age groups . Pediatric Diabetes . 2002;3:10–15
  11. Scrimgeour L, Cobry E, McFann K, Burdick P, Weimer C, Slover R, et al. Improved glycemic control after longterm insulin pump use in pediatric patients with type 1 diabetes . Diabetes Technol Ther . 2007;9:421–428
  12. Reda E , Von Reitzenstein A , Dunn P . Metabolic control with insulin pump therapy: the Waikato experience . N Z Med J . 2007;120:2401–2412
  13. Rizvi AA , Petry R , Arnold MB , Chakraborty M . Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes . Endocr Pract . 2001;7:364–369
  14. Kamoi K . Good long-term quality of life without diabetic complications with 20 years of continuous subcutaneous insulin infusion therapy in a brittle diabetic elderly patient . Diabetes Care . 2002;25:402–404
  15. American Association of Diabetes Educators  . Education for continuous subcutaneous infusion pump users . Diabetes Educ . 2003;29:97–99
  16. American Diabetes Association  . Continuous subcutaneous insulin infusion . Diabetes Care . 2004;27(Suppl 1):S110
  17. Lavin-Tompkins J . Insulin pump therapy: situations and solutions . Lippincotts Prim Care Pract . 1997;1:519–526
  18. de Weerdt I , Visser AP , Kok G , van der Veen EA . Determinants of active self-care behaviour of insulin treated patients with diabetes: implications for diabetes education . Soc Sci Med . 1999;30:605–615
  19. Bott U , Jorgens V , Grusser M , Bender R , Mühlhauser I , Berger M . Predictors of glycemic control in type 1 diabetic patients after participation in an intensified treatment and teaching programme . Diabet Med . 1994;11:362–371
  20. Kitabchi AE , Fisher JN , Burghen GA , Gaylord MS , Blank NM . Evaluation of a portable insulin infusion pump for outpatient management of brittle diabetes . Diabetes Care . 1979;2:421–424
  21. Levy-Marchal C , Czernichow P . Feasibility of continuous subcutaneous insulin infusion in young diabetic patients . Diabete Metab . 1988;14:108–113
  22. Steindel BS , Roe TR , Costin G , Carlson M , Kaufman FR . Continuous subcutaneous insulin infusion (CSII) in children and adolescents with chronic poorly controlled type 1 diabetes mellitus . Diabetes Res Clin Pract . 1995;27:199–204
  23. Boland EA , Grey M , Oesterle A , Fredrickson L , Tamborlane WV . Continuous subcutaneous insulin infusion: a new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes . Diabetes Care . 1999;22:1779–1784
  24. Hanas R , Ludvigsson J . Hypoglycemia and ketoacidosis with insulin pump therapy in children and adolescents . Pediatr Diabetes . 2006;7(Suppl 4):32–38
  25. Gabbe SG , Holing E , Temple P , Brown Z . Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus . Am J Obstet Gynecol . 2000;182:1283–1291
  26. Giménez M , Conget I , Nicolau J , Pericot A , Levy I . Outcome of pregnancy in women with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion or conventional therapy: a case-control study . Acta Diabetol . 2007;44:34–37

PII: S1726-4901(08)70138-2

doi:10.1016/S1726-4901(08)70138-2

Journal of the Chinese Medical Association
Volume 71, Issue 7 , Pages 353-356, July 2008

Article Tools