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[IP] CSII in Academic Diabetes Clinic



Abstract #:
 501 
  
Abstract Type:  Poster: Clinical Diabetes: Therapeutics/New Technology 
Abstract Category: Clinical Diabetes: Therapeutics/New Technology 
 
Abstract Schedule: 12:15 PM-2:15 PM, 6/12/2000  

An Assessment of Continuous Subcutaneous Insulin Infusion Therapy in an 
Academic Diabetes Clinic 
JUSTEN W. RUDOLPH, IRL B. HIRSCH 

Intensive diabetes management with continuous subcutaneous insulin infusion 
(CSII) has been associated with high discontinuation rates, severe 
hypoglycemia, site infections, and variable changes in HbA1c. We reviewed our 
experience of 107 patients (106 with type 1 diabetes) using CSII at the 
Diabetes Care Center (DCC) at the University of Washington.
All patients practicing intensive therapy [including multiple daily 
injections (MDI) and frequent self-monitoring of blood glucose (SMBG)] had 
extensive nutrition and diabetes education. Patients considering CSII at the 
DCC participated in a pre-pump" class to learn the details of this therapy.
The age of our population was 36.0 + 10.4 years (mean + SD). Women comprised 
69.2% of the study group, and 72.8% were married when CSII was initiated. The 
mean duration of diabetes at the start of pump therapy was 17.0 + 9.1 years. 
The mean duration of CSII use was 36.1 + 35.5 months (median = 26.2 months). 
Insulin lispro was used by 89.7% of the pump patients.
Six patients (5.6%) discontinued CSII after an average of 19.1 + 14.7 months 
for a variety of individual reasons. Although site infections were not listed 
as a reason for stopping CSII, there were 67.2 site infections/100 
patient-years in those who discontinued pump therapy compared to 8.4 site 
infections/100 patient-years in those who continued. Only one of the six 
patients (16.7%) had a history of psychiatric consultation for depression.
The findings of the analysis are included in the table:[table]In summary, in 
this academic diabetes clinic with a formal pump program we note a 
significant improvement in HbA1c and a reduction in the frequency of severe 
hypoglycemia. Pump discontinuation is rare, and depression is not common in 
those patients who stop pump therapy. CSII therapy when provided in 
conjunction with a standard education program should continue to be an 
important option to treat appropriate patients with type 1 diabetes."
 MDI CSII p value % Change 
SMBG (tests/day) 4.97 4.84 0.736 -2.6 
HbA1c (%) 7.6 7.1 <0.0001 -6.6 
Severe hypoglycemia (episodes/100 pt-yrs) 73.2 19.2 0.0003 -73.8 








 


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