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[IP] CSII vs. MIIT



IMPROVED GLYCEMIC CONTROL WITH USE OF CONTINUOUS SUBCUTANEOUS INSULIN 
INFUSION COMPARED WITH MULTIPLE INSULIN INJECTION THERAPY
David S. H. Bell, MB, FACE, and Fernando Ovalle, MD

ABSTRACT
Objective: To compare, in a long-term study, glycemic control by means of 
continuous subcutaneous insulin infusion (CSII or insulin pump therapy) 
versus multiple insulin injection therapy (MIIT) in routine clinical practice.

Methods: We identified, from a search of medical records, all active patients 
(N = 90) receiving CSII who had previously received MIIT. The primary 
objective was to compare the mean glycemic control, as documented by frequent 
measurements of glycosylated hemoglobin (HbA1c), during the 3-year period 
before initiation of CSII versus the mean glycemic control during the 3-year 
period after the first year of CSII. We included all patients for whom we had 
sufficient data for at least 1 year for both the pre- and post-CSII periods 
and only those patients who had received MIIT before CSII (N = 58). To 
eliminate potential biases, we excluded HbA1c values for the first year after 
initiation of CSII therapy.

Results: For the entire study group, the mean HbA1c  standard error for the 
3-year period before insulin pump therapy (during MIIT) was 8.4  0.2% versus 
a mean HbA1c of 7.7  0.1% for the 3-year period after the first year of 
CSII. This 0.7% improvement in HbA1c was statistically significant (P = 
0.001). Of the 34 patients with HbA1c values above 8.0% during MIIT, the mean 
HbA1c decreased from 9.2  0.2% with use of MIIT to 8.2  0.2% with CSII (P = 
0.0006). In the 17 patients with HbA1c values above 9.0% during MIIT, the 
mean HbA1c declined from 10.0  0.3% with use of MIIT to 8.4  0.3% with CSII 
(P = 0.0006).

Conclusion: We conclude that implementation of intensive insulin therapy with 
CSII improves glycemic control, even in patients in whom MIIT has previously 
been used to its maximal effect. (Endocr Pract. 2000;6:357-360)  <A 
HREF="http://www.aace.com/pub/epracticeindex.htm">AACE.COM: Publications: 
Endocrine Practice</A> 
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