Abstract and Introduction
Abstract
Objective: To determine the effectiveness of insulin pump use (continuous subcutaneous insulin infusion; CSII) in patients with type 2 diabetes (DM2) who have failed multiple daily injection (MDI) therapy.
Methods: In this retrospective study, charts of patients with DM2 who were started on CSII after failure of MDI were reviewed. Patients were categorized as primarily manual (fixed) bolus users or calculated (using pump software) bolus users. The change in hemoglobin A1c (HbA1c), weight, and basal insulin dose from baseline to 6 months was determined.
Results: Fifty-seven patients (20 men and 37 women) ranging in age from 13 to 71 were identified in the study. A significant reduction in HbA1c was observed from 8.75 to 7.69% (P<.001). There was an increase in body mass index (BMI) from a mean of 36.53 to a mean of 37.21. A decrease in basal insulin requirement per kilogram of weight (–0.10 U/kg) was noted (P = .03). Seven patients using U-500 insulin in the pump also had a significant decrease in HbA1C of 1.1 % (P<.001), along with a 0.071 U/kg drop in basal insulin requirements (P<.001). When comparing calculated bolus users to manual bolus users, there was no difference in HbA1C improvement (P = .58).
Conclusion: We found that CSII improves glucose control in patients with DM2 who have failed MDI despite a decrease in overall insulin requirements. This includes patients with severe insulin resistance using U-500 insulin. Use of frequent bolus adjustment incorporating carbohydrate counting and current glucose level does not appear to be required for this benefit.
Introduction
Insulin pump therapy (continuous subcutaneous insulin infusion; CSII) has been demonstrated to be effective in people with type 1 diabetes mellitus (DM1) and is experiencing increased use. This is due to the ability of CSII to mimic more closely the delivery of insulin provided by a normally functioning pancreas than other methods. In type 2 diabetes mellitus (DM2), insulin absence is typically more relative than absolute and is accompanied by insulin resistance. As a result, CSII in type DM2 has not received much attention.
However, people with DM2 often require insulin therapy, as progressive loss of pancreatic beta cell function occurs. Over one third of people with DM2 on multiple daily injections still do not achieve hemoglobin A1c (HbA1c) goal of <7%. Recently, CSII has been explored as an alternative to conventional multiple daily injections. At this time, the role of CSII in DM2 is unclear, as studies have provided inconsistent data.
Our goal in this study was to examine the results of CSII in patients with DM2 who had been failing intensive insulin therapy.