Efficacy of insulin pump therapy: mealtime delivery is the key factor
To investigate, in a clinical setting, the effect of implementation of continuous subcutaneous insulin infusion (CSII) on control of plasma glucose and to identify factors associated with improved glycemic control in patients with type 1 diabetes mellitus. Nineteen patients (16 women and 3 men) with...
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| Veröffentlicht in: | Endocrine practice 2000-05, Vol.6 (3), p.239-243 |
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| creator | Crawford, L M Sinha, R N Odell, R M Comi, R J |
| description | To investigate, in a clinical setting, the effect of implementation of continuous subcutaneous insulin infusion (CSII) on control of plasma glucose and to identify factors associated with improved glycemic control in patients with type 1 diabetes mellitus.
Nineteen patients (16 women and 3 men) with type 1 diabetes were studied retrospectively. Their mean age was 42.6 years (range, 30 to 58), and the mean duration of diabetes was 21 years. The subjects underwent follow-up for a mean of 14 months after conversion to CSII therapy. With use of paired t tests, pre-CSII and follow-up data were evaluated relative to changes in weight, insulin dosing, and glycosylated hemoglobin (HbA(1c)).
At follow-up, the total daily dose of insulin had decreased by 18%, from a baseline mean value of 45.2 IU to 37.1 IU (P = 0.02). HbA(1c) was reduced from 8.4% to 7.7% (P |
| doi_str_mv | 10.4158/ep.6.3.239 |
| format | Article |
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Nineteen patients (16 women and 3 men) with type 1 diabetes were studied retrospectively. Their mean age was 42.6 years (range, 30 to 58), and the mean duration of diabetes was 21 years. The subjects underwent follow-up for a mean of 14 months after conversion to CSII therapy. With use of paired t tests, pre-CSII and follow-up data were evaluated relative to changes in weight, insulin dosing, and glycosylated hemoglobin (HbA(1c)).
At follow-up, the total daily dose of insulin had decreased by 18%, from a baseline mean value of 45.2 IU to 37.1 IU (P = 0.02). HbA(1c) was reduced from 8.4% to 7.7% (P<0.01). The total daily insulin-to-weight ratio also significantly decreased from 0.66 IU/kg to 0.53 IU/kg (P<0.05). Before insulin pump use, the regular/NPH insulin ratio was 0.5 IU; at follow-up, the pump bolus/basal insulin ratio was 1.0 IU (P = 0.02). No weight gain was observed; the mean weight of the study patients decreased 0.2 kg, from 69.4 kg at baseline to 69.2 kg at follow-up (not significantly different).
In a clinical setting, CSII therapy in patients with type 1 diabetes improves glycemic control and lowers the total daily basal insulin dose without affecting weight. Improved glycemic control was associated with a shift in insulin therapy from a high percentage of intermediate-acting insulin to a greater percentage of insulin administered in a meal-associated bolus form. This study emphasizes the importance of mealtime insulin adjustment for tight glycemic control in patients using CSII therapy. Future studies evaluating the benefits of decreased total insulin and an increased bolus/basal insulin ratio may be important in helping to understand how to avoid long-term complications of diabetes.</description><identifier>ISSN: 1530-891X</identifier><identifier>EISSN: 1934-2403</identifier><identifier>DOI: 10.4158/ep.6.3.239</identifier><identifier>PMID: 11421538</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Adult ; Blood Glucose - metabolism ; Body Mass Index ; Body Weight - drug effects ; Diabetes Mellitus, Type 1 - drug therapy ; Eating - physiology ; Female ; Glycated Hemoglobin A - metabolism ; Humans ; Hypoglycemic Agents - administration & dosage ; Hypoglycemic Agents - therapeutic use ; Injections, Subcutaneous ; Insulin - administration & dosage ; Insulin - therapeutic use ; Insulin Infusion Systems ; Male ; Middle Aged ; Retrospective Studies ; Time Factors</subject><ispartof>Endocrine practice, 2000-05, Vol.6 (3), p.239-243</ispartof><rights>Copyright Allen Press Publishing Services May/Jun 2000</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c226t-997f58794b7b19148bc3dc094d58eb1dd26f0c09633f83ed29ff64ae1a99efd3</citedby><cites>FETCH-LOGICAL-c226t-997f58794b7b19148bc3dc094d58eb1dd26f0c09633f83ed29ff64ae1a99efd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1693333730?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,64385,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11421538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Crawford, L M</creatorcontrib><creatorcontrib>Sinha, R N</creatorcontrib><creatorcontrib>Odell, R M</creatorcontrib><creatorcontrib>Comi, R J</creatorcontrib><title>Efficacy of insulin pump therapy: mealtime delivery is the key factor</title><title>Endocrine practice</title><addtitle>Endocr Pract</addtitle><description>To investigate, in a clinical setting, the effect of implementation of continuous subcutaneous insulin infusion (CSII) on control of plasma glucose and to identify factors associated with improved glycemic control in patients with type 1 diabetes mellitus.
Nineteen patients (16 women and 3 men) with type 1 diabetes were studied retrospectively. Their mean age was 42.6 years (range, 30 to 58), and the mean duration of diabetes was 21 years. The subjects underwent follow-up for a mean of 14 months after conversion to CSII therapy. With use of paired t tests, pre-CSII and follow-up data were evaluated relative to changes in weight, insulin dosing, and glycosylated hemoglobin (HbA(1c)).
At follow-up, the total daily dose of insulin had decreased by 18%, from a baseline mean value of 45.2 IU to 37.1 IU (P = 0.02). HbA(1c) was reduced from 8.4% to 7.7% (P<0.01). The total daily insulin-to-weight ratio also significantly decreased from 0.66 IU/kg to 0.53 IU/kg (P<0.05). Before insulin pump use, the regular/NPH insulin ratio was 0.5 IU; at follow-up, the pump bolus/basal insulin ratio was 1.0 IU (P = 0.02). No weight gain was observed; the mean weight of the study patients decreased 0.2 kg, from 69.4 kg at baseline to 69.2 kg at follow-up (not significantly different).
In a clinical setting, CSII therapy in patients with type 1 diabetes improves glycemic control and lowers the total daily basal insulin dose without affecting weight. Improved glycemic control was associated with a shift in insulin therapy from a high percentage of intermediate-acting insulin to a greater percentage of insulin administered in a meal-associated bolus form. This study emphasizes the importance of mealtime insulin adjustment for tight glycemic control in patients using CSII therapy. Future studies evaluating the benefits of decreased total insulin and an increased bolus/basal insulin ratio may be important in helping to understand how to avoid long-term complications of diabetes.</description><subject>Adult</subject><subject>Blood Glucose - metabolism</subject><subject>Body Mass Index</subject><subject>Body Weight - drug effects</subject><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Eating - physiology</subject><subject>Female</subject><subject>Glycated Hemoglobin A - metabolism</subject><subject>Humans</subject><subject>Hypoglycemic Agents - administration & dosage</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Injections, Subcutaneous</subject><subject>Insulin - administration & dosage</subject><subject>Insulin - therapeutic use</subject><subject>Insulin Infusion Systems</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><issn>1530-891X</issn><issn>1934-2403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpFkEtLxDAUhYMojo5u_AEScCe05tU2cSdDfcCALmbhLqTNDXZspzVphf57M8yAd3Pv5XycAwehG0pSQTP5AEOapzxlXJ2gC6q4SJgg_DTeGSeJVPRzgS5D2BLCiKLyHC0oFSyK8gKVpXNNbeoZ9w43uzC1zQ4PUzfg8Qu8GeZH3IFpx6YDbKFtfsHPuAl7FX_DjJ2px95foTNn2gDXx71Em-dys3pN1u8vb6undVIzlo-JUoXLZKFEVVRUUSGrmtuaKGEzCRW1luWOxD_n3EkOlinncmGAGqXAWb5Edwfbwfc_E4RRb_vJ72KiprnicQpOInV_oGrfh-DB6cE3nfGzpkTvC9Plh84117GwCN8eLaeqA_uPHhvif6vuZXA</recordid><startdate>200005</startdate><enddate>200005</enddate><creator>Crawford, L M</creator><creator>Sinha, R N</creator><creator>Odell, R M</creator><creator>Comi, R J</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>200005</creationdate><title>Efficacy of insulin pump therapy: mealtime delivery is the key factor</title><author>Crawford, L M ; Sinha, R N ; Odell, R M ; Comi, R J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c226t-997f58794b7b19148bc3dc094d58eb1dd26f0c09633f83ed29ff64ae1a99efd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adult</topic><topic>Blood Glucose - metabolism</topic><topic>Body Mass Index</topic><topic>Body Weight - drug effects</topic><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Eating - physiology</topic><topic>Female</topic><topic>Glycated Hemoglobin A - metabolism</topic><topic>Humans</topic><topic>Hypoglycemic Agents - administration & dosage</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Injections, Subcutaneous</topic><topic>Insulin - administration & dosage</topic><topic>Insulin - therapeutic use</topic><topic>Insulin Infusion Systems</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Crawford, L M</creatorcontrib><creatorcontrib>Sinha, R N</creatorcontrib><creatorcontrib>Odell, R M</creatorcontrib><creatorcontrib>Comi, R J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Endocrine practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Crawford, L M</au><au>Sinha, R N</au><au>Odell, R M</au><au>Comi, R J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of insulin pump therapy: mealtime delivery is the key factor</atitle><jtitle>Endocrine practice</jtitle><addtitle>Endocr Pract</addtitle><date>2000-05</date><risdate>2000</risdate><volume>6</volume><issue>3</issue><spage>239</spage><epage>243</epage><pages>239-243</pages><issn>1530-891X</issn><eissn>1934-2403</eissn><abstract>To investigate, in a clinical setting, the effect of implementation of continuous subcutaneous insulin infusion (CSII) on control of plasma glucose and to identify factors associated with improved glycemic control in patients with type 1 diabetes mellitus.
Nineteen patients (16 women and 3 men) with type 1 diabetes were studied retrospectively. Their mean age was 42.6 years (range, 30 to 58), and the mean duration of diabetes was 21 years. The subjects underwent follow-up for a mean of 14 months after conversion to CSII therapy. With use of paired t tests, pre-CSII and follow-up data were evaluated relative to changes in weight, insulin dosing, and glycosylated hemoglobin (HbA(1c)).
At follow-up, the total daily dose of insulin had decreased by 18%, from a baseline mean value of 45.2 IU to 37.1 IU (P = 0.02). HbA(1c) was reduced from 8.4% to 7.7% (P<0.01). The total daily insulin-to-weight ratio also significantly decreased from 0.66 IU/kg to 0.53 IU/kg (P<0.05). Before insulin pump use, the regular/NPH insulin ratio was 0.5 IU; at follow-up, the pump bolus/basal insulin ratio was 1.0 IU (P = 0.02). No weight gain was observed; the mean weight of the study patients decreased 0.2 kg, from 69.4 kg at baseline to 69.2 kg at follow-up (not significantly different).
In a clinical setting, CSII therapy in patients with type 1 diabetes improves glycemic control and lowers the total daily basal insulin dose without affecting weight. Improved glycemic control was associated with a shift in insulin therapy from a high percentage of intermediate-acting insulin to a greater percentage of insulin administered in a meal-associated bolus form. This study emphasizes the importance of mealtime insulin adjustment for tight glycemic control in patients using CSII therapy. Future studies evaluating the benefits of decreased total insulin and an increased bolus/basal insulin ratio may be important in helping to understand how to avoid long-term complications of diabetes.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>11421538</pmid><doi>10.4158/ep.6.3.239</doi><tpages>5</tpages></addata></record> |
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| ispartof | Endocrine practice, 2000-05, Vol.6 (3), p.239-243 |
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| subjects | Adult Blood Glucose - metabolism Body Mass Index Body Weight - drug effects Diabetes Mellitus, Type 1 - drug therapy Eating - physiology Female Glycated Hemoglobin A - metabolism Humans Hypoglycemic Agents - administration & dosage Hypoglycemic Agents - therapeutic use Injections, Subcutaneous Insulin - administration & dosage Insulin - therapeutic use Insulin Infusion Systems Male Middle Aged Retrospective Studies Time Factors |
| title | Efficacy of insulin pump therapy: mealtime delivery is the key factor |
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