Intensified Insulin Therapy in the Type I Diabetic Adolescent: A Controlled Trial

The effects of continuous subcutaneous insulin infusion (CSII), intensified conventional therapy (ICT), and a combination of CSII and ICT (CSII-ICT) on metabolic control were compared in a group of twenty type I diabetic adolescents who had previously failed to respond to twice-daily injections and home glucose monitoring. A marked improvement in control was observed when mean glycemia and glycosylated hemoglobin A₁ (HbA₁) were compared with conventional therapy (CT). In the course of CSII, a lower HbA₁ (P < 0.05) and mean capillary blood glucose (CBG) (P < 0.04) were observed than during ICT and CSII-ICT. Acceptability of CSII was greater that of ICT and CSII-ICT, with 50% of the patients opting for this therapy at the end of the 1-yr trial. The marked improvement of control observed under CSII for the group as a whole was maintained after 6 mo of completion of the study. Thus, it appears that in type I diabetic adolescents CSII is more effective and acceptable than ICT and CSII-ICT.