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Optimization of basal insulin delivery in Type 1 diabetes: a retrospective study on the use of continuous subcutaneous insulin infusion and insulin glargine
Author(s) -
Fahlén M.,
Eliasson B.,
Odén A.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2004.01444.x
Subject(s) - medicine , insulin glargine , insulin , diabetes mellitus , logistic regression , basal (medicine) , type 1 diabetes , confounding , metabolic control analysis , type 2 diabetes , endocrinology
Aims To compare the effects on glycaemic control after using continuous subcutaneous insulin infusion (CSII) or insulin glargine. Methods Data were obtained from 17 diabetes outpatient clinics in Sweden, employing the same diabetes data management system. Type 1 diabetic patients using multiple dose injections were included prior to starting on either CSII ( n = 563) or glargine ( n = 513). The median duration of therapy was 25 months for CSII and 6 months for glargine. The comparison between the treatment modalities was carried out by multiple regression analysis and logistic regression analysis in an attempt at reducing the influence of confounding factors. Results The mean HbA 1c decrease was 0.59 ± 1.19% for CSII and 0.20 ± 1.07% for glargine ( P < 0.001, when assessed by logistic regression). An additional 0.1% lower HbA 1c would be expected if glargine had been optimized with basal insulin 40–60% of the daily dose. The more pronounced effect of CSII was achieved with a lower daily dosage of insulin. In a multiple regression analysis with a change of HbA 1c as the dependent variable, the following variables were significant: choice of treatment ( P < 0.001), HbA 1c prior to treatment ( P < 0.001) and BMI prior to treatment ( P < 0.01). Conclusion Both regimes improved metabolic control, but CSII resulted in significantly higher reduction in HbA 1c than after insulin glargine treatment, particularly in those individuals who had higher levels of HbA 1c at baseline.