Complex Assessment of Metabolic Effectiveness of Insulin Pump Therapy in Patients with Type 2 Diabetes Beyond HbA1c Reduction.

ABSTRACT: BACKGROUND:This prospective single-center study recruited insulin-resistant continuous subcutaneous insulin infusion (CSII) therapy-naive patients with type 2 diabetes (T2D) using insulin analog-based multiple daily injections (MDI) therapy and metformin. METHODS:A total of 23 individuals with T2D (70% male), aged a mean?±?standard deviation 57.2?±?8.03 years, with body mass index of 36.2?±?7.02?kg/m2, diabetes duration of 13.3?±?4.64 years, and HbA1c of 10.0%?±?1.05% were randomly assigned to a CSII arm or an MDI continuation arm to explore glucose control, weight loss, total daily insulin dose (TDD), and insulin resistance. Insulin dosing was optimized over a 2-month run-in period. RESULTS:At 6 months, patients assigned to the CSII arm achieved a significant mean HbA1c reduction of -0.9% (95% confidence interval [CI]?=?-1.6, -0.1), while reducing their TDD by -29.8?±?28.41?U/day (33% of baseline [92.1?±?20.35?U/day]) and achieving body mass (BM) reduction of -0.8?±?5.61?kg (0.98% of baseline [104.8?±?16.15?kg]). MDI patients demonstrated a nonsignificant HbA1c reduction of -0.3% (95% CI?=?-0.8, 0.1) with a TDD reduction of 5% from baseline (99.0?±?25.25?U/day to 94.3?±?21.25?U/day), and a BM reduction of -1.0?±?2.03?kg (0.99% of baseline [108.9?±?20.55?kg]). After 6 months, the MDI arm crossed over to CSII therapy. At 12 months, patients continuing CSII demonstrated an additional mean 0.7% HbA1c reduction with 54.6% achieving HbA1c<8%. The final TDD reduction was -9.7?U/day in comparison to baseline; BM increased by 1.1?±?6.5?kg from baseline. The MDI patients that crossed to CSII showed an HbA1c reduction of -0.5%?±?1.04%, HbA1c response rate of 27.3%, a TDD reduction of -17.4?±?21.06?U/day, and a BM reduction of -0.3?±?3.39?kg. Diabetic ketoacidosis or severe hypoglycemia did not occur in either arm. CONCLUSION:CSII therapy safely and significantly improved metabolic control with less insulin usage, with no sustainable reduction of BM, blood pressure, and lipid profile, in insulin-resistant T2D patients. Treatment adherence and satisfaction in these patients were excellent.

SUBMITTER: Chlup R 

PROVIDER: S-EPMC5771538 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature