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[IP] Abstract: Factors Affecting the Reduction of Starting Insulin Dosein CSII

Abstract #:
0264 Abstract Category:Clinical Diabetes, Therapeutics/New Technology 

Factors Affecting the Reduction of Starting Insulin Dose in Continuous 
Subcutaneous Insulin Infusion (CSII): A Review of 389 Pump Initiations. 

Bruce W. Bode*, Atlanta Diabetes Associates, Atlanta, GA; Todd M. Gross, 
Mark B. Ghegan, Paul C. Davidson*, MiniMed Inc., Sylmar, CA 

With the increased usage of insulin pump therapy in the United States 
(industry estimates indicate a three fold increase over the last 5 years 
to approximately 60,000 Type 1 patients at the end of 1998), improved 
guidelines are needed to aid physicians in initiating this form of 
intensive insulin therapy. The authors hypothesize that a significant 
reduction in insulin dosage occurs when switching from multiple daily 
injections (MDI) to CSII and that there may be identifiable factors that 
influence the magnitude of this reduction. A total of 389 MDI patients 
were initiated on CSII. Average age was 33  SD 12 years; average 
duration of diabetes was 15  10 years; 57% were female. Insulin dosage 
during MDI therapy was 48  18 units. Patients showed a significant 
decrease from baseline insulin dosage within 15 days of initiation of 
CSII therapy (average decrease 26  14%, p<0.0001). This decrease 
persisted at 6 months (15  19%, p<0.0001) and at 18 months (11  23%, p
<0.0001). HbA1c improved significantly post CSII initiation, decreasing 
from 8.27  1.76% at initiation to 7.38  1.44% six months post CSII and 
7.43  1.34% at 18 months. Two primary factors influenced the size of 
the insulin dosage reduction. The average reduction seen immediately 
following pump initiation was greater for patients transferred to lispro 
(29  12%) than for patients transferred to buffered human regular 
insulin (25  14%), p=0.007. Similar significant differences persisted 
at 6 and 18 months post-initiation. Higher insulin dosage during MDI was 
correlated with greater percent reduction at 15 days, 6 months and 18 
months (r=0.42, 0.42 and 0.45, all p<0.0001). Multivariate analysis 
indicates that HbA1c, number of injections per day, percent of 
long-acting insulin, weight, age, and sex were not significant factors 
in the percent reduction of insulin dosage. The data demonstrate a 
significant and sustained reduction in insulin dosage in CSII patients, 
coupled with a significant and sustained improvement in HbA1c. 
Guidelines for initiating a patient on CSII should include a substantial 
reduction in total insulin dosage at start of therapy (average 26%), 
with greater percentage reductions for patients initiated on lispro, and 
for those with higher daily insulin dosages. 
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