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[IP] CSII IN OLDER PATIENTS WITH LONG-STANDING TYPE 1 DIABETES



 <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11585372&dopt=Abstract">Entrez-PubMed</A> 

Endocr Pract 2001 Sep-Oct;7(5):364-369      

BENEFICIAL EFFECTS OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION IN OLDER 
PATIENTS WITH LONG-STANDING TYPE 1 DIABETES.

Rizvi AA, Petry R, Arnold MB, Chakraborty M.

Internal Medicine and Endocrine Associates of Augusta, Diabetes Program, 
University Hospital, and Medical College of Georgia, Augusta, Georgia. 
Address correspondence and reprint requests to Dr. A. A. Rizvi, Internal 
Medicine and Endocrine Associates of Augusta, 820 Saint Sebastian Way, Suite 
7A, Augusta, GA 30901.

Objective: To assess the effect of continuous subcutaneous insulin infusion 
(CSII) on glycemic control, hypoglycemia, and daily insulin requirements in 
five older patients with long-standing type 1 diabetes previously treated 
with multiple-dose insulin injections (MDII). Methods: We undertook a 
retrospective analysis of five older patients (three women and two men) with 
type 1 diabetes and a mean age of 66.4 years (range, 57 to 76). The mean 
duration of disease was 33 years (range, 18 to 49), and all patients had 
suboptimal glycemic control (glycosylated hemoglobin or HbA1c >8.0%), 
presence of microvascular complications, and unacceptably frequent 
hypoglycemia during MDII therapy. A diabetes care team monitored their 
clinical course after their treatment was changed to a CSII regimen. Data 
pertaining to HbA1c, severe hypoglycemia, and insulin dose before and after 
conversion to CSII were compared with use of paired t tests. Results: After 
initiation of CSII therapy, the mean HbA1c value decreased from 9.16% to 7.6% 
(P<0.0025), the rate of severe hypoglycemia decreased from 3.2 episodes to 
0.4 episode per year (P<0.02), and the mean total daily insulin dose was 
reduced from 44.9 IU to 32.4 IU (P<0.05) during a mean duration of 12.6 
months of CSII therapy. Conclusion: Insulin pump therapy can prove highly 
beneficial in older patients with type 1 diabetes by improving glycemic 
control, reducing hypoglycemic episodes and insulin dosage, and possibly 
increasing treatment satisfaction. These changes can potentially prevent 
morbidity and prove to be cost-effective. For implementation of pump 
conversion to be safe and successful, careful patient selection, proper 
education, and ongoing support through a comprehensive diabetes education and 
management program are imperative. Future reports of experience with CSII in 
elderly patients should help to elucidate its promising advantages in this 
patient population and provide guidelines for use.

PMID: 11585372 [PubMed - as supplied by publisher]  
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