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[IP] CSII vs. MDI with Lispro

Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily 
Injection Regimens Using Insulin Lispro in Type 1 Diabetic Patients on 
Intensified Treatment
A randomized study

Hélène Hanaire-Broutin, MD
Vincent Melki, MD
Sylvie Bessières-Lacombe, MD
Jean-Pierre Tauber, MD
The Study Group for the Development of Pump Therapy in Diabetes

OBJECTIVE — To compare the efficacy of 2 intensified insulin regimens, 
continuous subcutaneous insulin infusion (CSII) and multiple daily injections 
(MDI), by using the short-acting insulin analog lispro in type 1 diabetic 

RESEARCH DESIGN AND METHODS — A total of 41 C-peptide–negative type 1 
diabetic patients (age 43.5 ± 10.3 years; 21 men and 20 women, BMI 24.0 ± 2.4 
kg/m2, diabetes duration 20.0 ± 11.3 years) on intensified insulin therapy 
(MDI with regular insulin or lispro, n = 9; CSII with regular insulin, n = 
32) were included in an open-label randomized crossover study comparing two 
4-month periods of intensified insulin therapy with lispro: one period by MDI 
and the other by CSII. Blood glucose (BG) was monitored before and after each 
of the 3 meals each day.

RESULTS — The basal insulin regimen had to be optimized in 75% of the 
patients during the MDI period (mean number of NPH injections per day = 
2.65). HbA1c values were lower when lispro was used in CSII than in MDI (7.89 
± 0.77 vs. 8.24 ± 0.77%, P < 0.001). BG levels were lower with CSII (165 ± 27 
vs. 175 ± 33 mg/dl, P < 0.05). The SD of all the BG values (73 ± 15 vs. 82 ± 
18 mg/dl, P < 0.01) was lower with CSII. The frequency of hypoglycemic 
events, defined as BG levels <60 mg/dl, did not differ significantly between 
the 2 modalities (CSII 3.9 ± 4.2 per 14 days vs. MDI 4.3 ± 3.9 per 14 days). 
Mean insulin doses were significantly lower with CSII than with MDI (38.5 ± 
9.8 vs. 47.3 ± 14.9 U/day, respectively, P < 0.0001).

CONCLUSIONS — When used with external pumps versus MDI, lispro provides 
better glycemic control and stability with much lower doses of insulin and 
does not increase the frequency of hypoglycemic episodes.

Diabetes Care 23:1232–1235, 2000



Copyright © 2000 American Diabetes Association 

Last updated: 8/00
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