The importance of achieving and maintaining tight glycemic control in patients with type 1 diabetes is well known (1). Continuous insulin infusion therapy (CSII) has been available for many years, but only recently have reports of efficacy with rapid-acting insulin analogues been published. Similarly, multiple daily injection (MDI) therapy using glargine insulin in conjunction with premeal rapid-acting insulin is relatively new (2).
In our diabetes center, all patients with type 1 diabetes receive the same diabetes education, including instruction in carbohydrate counting. All patients are given the option of either CSII or MDI therapy and are encouraged to use whichever treatment maintains their blood glucose levels as close to normal as possible.
To assess our quality of care, we performed a random chart audit of 150 patients. To be included in the analysis, patients had to have type 1 diabetes and be treated for at least 6 months with either CSII using rapid-acting insulin (lispro or aspart) or MDI with insulin glargine with premeal rapid-acting insulin. Patients who were pregnant, <15 years of age, or referred for treatment of severe recurrent hypoglycemia were excluded.
There were 103 patients who met our criteria; 58 were on CSII and 45 were on MDI therapy. Glargine was given in the morning in 11%, in the evening in 60%, and twice a day in 29% of patients. Age, duration of diabetes, and incidence of complications were similar in both groups. Duration of therapy was 16.0 ± 5.8 (means ± SD) (CSII) vs. 11.6 ± 3.8 months (MDI) (P < 0.0001). Most recent A1C levels were the same in both groups—6.79 ± 1.07 (CSII) vs. 6.84 ± 0.90% (MDI) (P = 0.82). One patient in the CSII group and two patients in the MDI group had an episode of severe hypoglycemia. One patient in the CSII group had two episodes of diabetic ketoacidosis.
Therefore, both CSII and MDI therapy can be used to treat patients with type 1 diabetes to target. Prospective data are needed to confirm the findings of this cross-sectional analysis.
A.P.H. has received honoraria from and served on advisory boards for NovoNordisk, Aventis, and Lilly and has received research support from Minimed and Aventis. R.M. is a member of the Aventis speaker bureau.
