Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections: The Impact of Baseline A1c: Response to Retnakaran et al.

Retnakaran et al.’s (1) recent pooled analysis showed improved glycemic control (when using rapid-acting insulin analogs) with continuous subcutaneous insulin infusion (CSII) therapy compared with multiple daily insulin injection (MDII). However, given that CSII users are known to be a well-motivated patient population with far greater adherence to particularly frequent glucose monitoring (often seven or more times per day) and also to have frequent contact with diabetes educators (specifically pump trainers), one wonders if similarly motivated, MDII-treated individuals might have had equivalent improvement in glycemic control. Do Retnakaran et al. have data reflecting objective determination of measures of motivation and adherence (such as frequency of blood-glucose monitoring, frequency of contact with diabetes educators, use or non-use of carbohydrate counting, etc.)? If so, could they comment as to whether this additional information would impact their analysis and conclusions?