Comparison of continuous subcutaneous insulin infusion and insulin glargine-based multiple daily insulin aspart injections with preferential adjustment of basal insulin in patients with type 2 diabetes

Gao,Guan-Qi; Heng,Xue-Yuan; Wang,Yue-Li; Li,Wen-Xia; Dong,Qing‑Yu; Liang,Cui‑Ge; Du,Wen-Hua; Liu,Xiao-Meng

doi:10.3892/etm.2014.1866

Comparison of continuous subcutaneous insulin infusion and insulin glargine-based multiple daily insulin aspart injections with preferential adjustment of basal insulin in patients with type 2 diabetes

Authors:
- Guan-Qi Gao
- Xue-Yuan Heng
- Yue-Li Wang
- Wen-Xia Li
- Qing‑Yu Dong
- Cui‑Ge Liang
- Wen-Hua Du
- Xiao-Meng Liu
View Affiliations

Affiliations: Department of Endocrinology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China, Department of Clinical Medicine, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
Published online on: July 29, 2014 https://doi.org/10.3892/etm.2014.1866
Pages: 1191-1196

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The purpose of this study was to evaluate and compare multiple daily injection (MDI) therapy of bolus insulin aspart and basal insulin glargine with continuous subcutaneous insulin infusion (CSII) with aspart in patients with type 2 diabetes mellitus (T2DM). It was assessed whether MDI was capable of controlling glycemic index with a higher efficacy than CSII by preferential adjustment of basal insulin with a lower total daily insulin dosage in T2DM. Two hundred patients with T2DM were enrolled in the study and randomly assigned to CSII (n=100) and MDI (n=100; aspart immediately prior to each meal and glargine at bedtime) groups for 12 weeks of therapy. During the last week of each treatment period, the subjects wore a continuous glucose monitoring system for 2‑3 days. The dosage of basal insulin was preferentially adjusted to control prior‑meal blood glucose levels, and the characteristics of insulin dosage were analyzed. No statistically significant differences were observed between the two groups in hemoglobin A1c (HbA1c), which dropped from 10‑11% prior to therapy to 7‑7.5% after 12 weeks. After 12 weeks, good glycemic level control was achieved in all patients in the MDI and CSII groups. A statistically significant difference in the dose of insulin between the CSII and MDI groups was observed (P<0.001). In conclusion, no significant differences were found between the two therapies in the incidence of hypoglycemia and HbA1c for the 12 weeks. The basal insulin dosage was significantly decreased in the MDI group compared with that in the CSII group, but the CSII group was superior to MDI group in decreasing fasting blood glucose and shortening the time required for hypoglycemia to meet the targeted level.

View Figures

View References

1	Lindholm A, McEwen J and Riis AP: Improved postprandial glycemic control with insulin aspart. A randomized double-blind cross-over trial in type 1 diabetes. Diabetes Care. 22:801–805. 1999. View Article : Google Scholar : PubMed/NCBI
2	Anderson JH Jr, Brunelle RL, Koivisto VA, et al: Reduction of postprandial hyperglycemia and frequency in hypoglycemia in IDDM patients on insulin-analog treatment. Multicenter Insulin Lispro Study Group. Diabetes. 46:265–270. 1997. View Article : Google Scholar : PubMed/NCBI
3	Raskin P, Klaff L, Bergenstal R, et al: A 16-week comparison of the novel insulin analog insulin glargine (HOE901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes. Diabetes Care. 23:1666–1671. 2000. View Article : Google Scholar : PubMed/NCBI
4	Lepore M, Pampanelli S, Fanelli C, et al: Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 49:2142–2148. 2000. View Article : Google Scholar
5	Pickup J and Keen H: Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care. 25:593–598. 2002.PubMed/NCBI
6	Reynolds LR: Reemergence of insulin pump therapy in the 1990s. South Med J. 93:1157–1161. 2000. View Article : Google Scholar : PubMed/NCBI
7	Bode BW, Steed RD and Davidson PC: Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type 1 diabetes. Diabetes Care. 19:324–327. 1996. View Article : Google Scholar : PubMed/NCBI
8	Bode BW, Weinstein R, Bell D, et al: Comparison of insulin aspart with buffered regular insulin and insulin lispro in continuous subcutaneous insulin infusion: a randomized study in type I diabetes. Diabetes Care. 25:439–444. 2002. View Article : Google Scholar : PubMed/NCBI
9	Bode B and Strange P: Efficacy, safety, and pump compatibility of insulin aspart used in continuous subcutaneous insulin infusion therapy in patients with type 1 diabetes. Diabetes Care. 24:69–72. 2001. View Article : Google Scholar : PubMed/NCBI
10	Tsui E, Barnie A, Ross S, et al: Intensive insulin therapy with insulin lispro: a randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection. Diabetes Care. 24:1722–1727. 2001. View Article : Google Scholar : PubMed/NCBI
11	Elbein SC, Wegner K and Kahn SE: Reduced beta-cell compensation to the insulin resistance associated with obesity in members of caucasian familial type 2 diabetic kindreds. Diabetes Care. 23:221–227. 2000. View Article : Google Scholar : PubMed/NCBI
12	Yang W, Lu J, Weng J, et al; China national Diabetes and Metabolic Disorders Study Group. Prevalence of diabetes among men and women in China. N Engl J Med. 362:1090–1101. 2010. View Article : Google Scholar : PubMed/NCBI
13	An YL, Gao Y, Zhu Q, et al: Features of insulin secretion and insulin resistance in newly diagnosed type 2 diabetes of different body mass indices. Zhonghua Yi Xue Za Zhi. 24:256–260. 2008.(In Chinese).
14	Juan CC, Fang VS, Kwok CF, et al: Exogenous hyperinsulinemia causes insulin resistance, hyperendothelinemia, and subsequent hypertension in rats. Metabolism. 48:465–471. 1999. View Article : Google Scholar : PubMed/NCBI
15	Bruttomesso D, Pianta A, Crazzolara D, et al: Continuous subcutaneous insulin infusion (CSII) in the Veneto region: efficacy, acceptability and quality of life. Diabet Med. 19:628–634. 2002. View Article : Google Scholar : PubMed/NCBI
16	Weissberg-Benchell J, Antisdel-Lomaglio J and Seshadri R: Insulin pump therapy: a meta-analysis. Diabetes Care. 26:1079–1087. 2003. View Article : Google Scholar : PubMed/NCBI
17	Bruttomesso D, Crazzolara D, Maran A, et al: In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine. Diabet Med. 25:326–332. 2008. View Article : Google Scholar
18	Jothydev Kesavadev J, Balakrishnan S, Ahammed S and Jothydev S: Reduction of glycosylated hemoglobin following 6 months of continuous subcutaneous insulin infusion in an Indian population with type 2 diabetes. Diabetes Technol Ther. 11:517–21. 2009.PubMed/NCBI
19	Torres I, Ortego J, Valencia I, et al: Benefits of continuous subcutaneous insulin infusion in type 1 diabetes previously treated with multiple daily injections with once-daily glargine and pre-meal analogues. Exp Clin Endocrinol Diabetes. 117:378–385. 2009. View Article : Google Scholar
20	Phillip M, Battelino T, Rodriguez H, et al; European Society for Paediatric Endocrinology; Lawson Wilkins Pediatric Endocrine Society; International Society for Pediatric and Adolescent Diabetes; American Diabetes Association; European Association for the Study of Diabetes. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 30:1653–1662. 2007.
21	Monami M, Lamanna C, Marchionni N and Mannucci E: Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes: a meta-analysis. Exp Clin Endocrinol Diabetes. 117:220–222. 2009. View Article : Google Scholar : PubMed/NCBI
22	Kesavadev J, Balakrishnan S, Ahammed S and Jothydev S: Reduction of glycosylated hemoglobin following 6 months of continuous subcutaneous insulin infusion in an Indian population with type 2 diabetes. Diabetes Technol Ther. 11:517–521. 2009. View Article : Google Scholar : PubMed/NCBI
23	Carotenuto M, Esposito M, Parisi L, et al: Depressive symptoms and childhood sleep apnea syndrome. Neuropsychiatr Dis Treat. 8:369–373. 2012. View Article : Google Scholar : PubMed/NCBI
24	Verrotti A, Agostinelli S, D’Egidio C, et al: Impact of a weight loss program on migraine in obese adolescents. Eur J Neurol. 20:394–397. 2013. View Article : Google Scholar : PubMed/NCBI
25	Carotenuto M, Santoro N, Grandone A, et al: The insulin gene variable number of tandem repeats (INS VNTR) genotype and sleep disordered breathing in childhood obesity. J Endocrinol Invest. 32:752–755. 2009. View Article : Google Scholar : PubMed/NCBI
26	Carotenuto M, Bruni O, Santoro N, et al: Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: a questionnaire-based study. Sleep Med. 7:357–361. 2006. View Article : Google Scholar : PubMed/NCBI
27	Hoogma RP, Hammond PJ, Gomis R, et al; 5-Nations Study Group. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med. 23:141–147. 2006. View Article : Google Scholar
28	Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 28:1245–1249. 2005. View Article : Google Scholar : PubMed/NCBI
29	Marcovecchio ML, Lucantoni M and Chiarelli F: Role of chronic and acute hyperglycemia in the development of diabetes complications. Diabetes Technol Ther. 13:389–394. 2011. View Article : Google Scholar : PubMed/NCBI
30	Ceriello A and Ihnat MA: ‘Glycaemic variability’: a new therapeutic challenge in diabetes and the critical care setting. Diabet Med. 27:862–867. 2010.
31	Bragd J, von Döbeln A, Lins PE, et al: Basal insulin substitution with glargine or continuous subcutaneous insulin infusion in adult type 1 diabetes patients-a randomized controlled trial. Diabetes Technol Ther. 12:689–693. 2010. View Article : Google Scholar
32	Tone A, Iseda I, Higuchi C, et al: Comparison of insulin detemir and insulin glargine on glycemic variability in patients with type 1 and type 2 diabetes. Exp Clin Endocrinol Diabetes. 118:320–324. 2010. View Article : Google Scholar : PubMed/NCBI
33	Suzuki D, Toyoda M, Kondo M, et al: Efficacy of long-acting insulin analog insulin glargine at high dosage for basal-bolus insulin therapy in patients with type 2 diabetes. Tokai J Exp Clin Med. 37:35–40. 2012.PubMed/NCBI
34	Cai X, Han X, Luo Y and Ji L: Analysis of insulin doses of Chinese type 2 diabetic patients with intensive insulin treatment. PLoS One. 7:e389622012. View Article : Google Scholar : PubMed/NCBI
35	Kelley D, Mokan M and Veneman T: Impaired postprandial glucose utilization in non-insulin-dependent diabetes mellitus. Metabolism. 43:1549–1557. 1994. View Article : Google Scholar : PubMed/NCBI