Beneficial effects of continuous subcutaneous insulin infusion and flexible multiple daily insulin regimen using insulin glargine in type 1 diabetes

Objective. The aim of this study was to evaluate the metabolic effects of continuous subcutaneous insulin infusion (CSII) with flexible multiple daily insulin (FMDI; premeal lispro + bedtime glargine) therapy as determined by glycosylated hemoglobin (Hb[A.sub.1c]), body mass index (BMI), and hypoglycemic episodes in a group of patients who made the transition from multiple daily insulin (premeal lispro + bid ultralente) to either CSII or FMDI therapy. Methods. Data from 40 (27 female and 13 male) patients (10.1-17.8 years of age) who were on CSII and 40 age- and gender-matched (27 female and 13 male) patients (10.3-17.3 years of age) who were on FMDI were collected during regularly scheduled visits at a similar frequency over a 1-year period. Results. The total daily insulin dose did not change in CSII (0.97 [+ or -] 0.24 vs 0.91 [+ or -] 0.22 U/kg) and FMDI (0.98 [+ or -] 0.21 vs 0.97 [+ or -] 0.21 U/kg) patients, whereas the bolus: basal insulin ratio was significantly increased in both CSII (1.01 [+ or -] 0.43 vs 1.32 [+ or -] 0.52) and FMDI (1.07 [+ or -] 0.0.41 vs 1.29 [+ or -] 0.47) patients. The total cohort of CSII patients showed a decrease in Hb[A.SUB.1c] from 8.4 [+ or -] 1.0% to 7.8 [+ or -] 0.8%, whereas the FMDI cohort did not show a significant change in Hb[A.sub.1c] (8.5 [+ or -] 1.1% to 8.2 [+ or -] 0.9%). How ever, 40% of the CSII group and 22.5% of the FMDI group showed [greater than or equal to] 1.0% improvement in Hb[A.sub.1c]. Also, a similar number of patients in CSII (52.5%; 8.0 [+ or -] 1.1 to 7.2 [+ or -] 0.5%) and FMDI (47.5%; 8.0 [+ or -] 0.5% to 7.5 [+ or -] 0.4%) maintained or achieved target Hb[A.sub.1c] values