[Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections]

CSII is related to more stable glycemia in adults with type 1 diabetes

PURPOSE

The purpose of the present study was to compare the basic glycemic control parameters-HbA1c, CV%, and hypoglycemia, as well as quality of life and depression score in patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).

METHODS

324 adult patients with type 1 diabetes-146 using CSII and 178 on MDI, were enrolled in this cross-sectional study. HbA1c was assessed in whole blood by immuno-turbidimetric NGSP certified method. CV% was derived from CGM or was calculated from a 9-point capillary blood glucose profile. Hypoglycemia frequency, severity, and awareness were assessed using Clarke's hypoglycemia questionnaire. Quality of life (QOL) was assessed using a questionnaire by the Psychiatric Research Unit and the CES-D scale.

RESULTS

CSII group compared to MDI group showed significantly lower HbA1c-7.3% (6.6-8.0%) vs 8.2% (7.2-9.6%) (p < 0.0001), lower CV 27.2% (±9.8) vs 34.7% (±11.3) (p < 0.0001), fewer hypoglycemia episodes (p < 0.0001). There was no significant difference in the frequency of severe hypoglycemia, hypoglycemia awareness, QOL, and depression scores between the two groups.

CONCLUSIONS

CSII in type 1 diabetes is related to better and more stable glycemic control compared to MDI.

Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics

The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.