Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes

Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes A randomized, parallel-group, 24-week study Philip Raskin , MD 1 , Bruce W. Bode , MD 2 , Jennifer B. Marks , MD 3 , Irl B. Hirsch , MD 4 , Richard L. Weinstein , MD 5 , Janet B. McGill , MD 6 , Gregory E. Peterson , DO 7 , Sunder R. Mudaliar , MD 8 and Rickey R. Reinhardt , MD, PHD 9 1 University of Texas, Southwestern Medical Center, Dallas, Texas 2 Atlanta Diabetes Associates, Atlanta, Georgia 3 University of Miami, Miami, Florida 4 University of Washington, Seattle, Washington 5 Diablo Clinical Research, Walnut Creek, Californnia 6 Washington University, St. Louis, Missouri 7 Diagnostic and Critical Care Medicine, Des Moines, Iowa 8 VA Medical Center, San Diego, California 9 Novo Nordisk Pharmaceuticals, Princeton, New Jersey Address correspondence and reprint requests to Philip Raskin, MD, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8858. E-mail: praski{at}mednet.swmed.edu Abstract OBJECTIVE —Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS —A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA 1c and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings. RESULTS —HbA 1c values decreased similarly for both groups from baseline (8.2 ± 1.37% for CSII, 8.0 ± 1.08% for MDI) to end of study (7.6 ± 1.22% for CSII, 7.5 ± 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 ± 48 vs. 192 ± 65 mg/dl for CSII and MDI, respectively; P = 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups. CONCLUSIONS —Insulin aspart in CSII therapy provided effic