Skip to main content
SpringerLink
Log in

CSII is related to more stable glycemia in adults with type 1 diabetes

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the present study was to compare the basic glycemic control parameters—HbA1c, CV%, and hypoglycemia, as well as quality of life and depression score in patients with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).

Methods

324 adult patients with type 1 diabetes—146 using CSII and 178 on MDI, were enrolled in this cross-sectional study. HbA1c was assessed in whole blood by immuno-turbidimetric NGSP certified method. CV% was derived from CGM or was calculated from a 9-point capillary blood glucose profile. Hypoglycemia frequency, severity, and awareness were assessed using Clarke’s hypoglycemia questionnaire. Quality of life (QOL) was assessed using a questionnaire by the Psychiatric Research Unit and the CES-D scale.

Results

CSII group compared to MDI group showed significantly lower HbA1c—7.3% (6.6–8.0%) vs 8.2% (7.2–9.6%) (p < 0.0001), lower CV 27.2% (±9.8) vs 34.7% (±11.3) (p < 0.0001), fewer hypoglycemia episodes (p < 0.0001). There was no significant difference in the frequency of severe hypoglycemia, hypoglycemia awareness, QOL, and depression scores between the two groups.

Conclusions

CSII in type 1 diabetes is related to better and more stable glycemic control compared to MDI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. R.P. Radermecker, A.J. Scheen,, Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness. Diabetes Metab. Res. Rev. 20(3), 178–188 (2004). https://doi.org/10.1002/dmrr.447.

    Article  CAS  PubMed  Google Scholar 

  2. National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. https://www.nice.org.uk/guidance/ng3/chapter/Recommendations (2015). Accessed 01 July 2021.

  3. U. Mantaj, P. Gutaj, K. Ozegowska, A. Zawiejska, K. Wroblewska-Seniuk, D. Olejniczak, E. Wender-Ozegowska, Continuous subcutaneous insulin infusion reduces neonatal risk in pregnant women with type 1 diabetes mellitus. Ginekol Pol. 90(3), 154–160 (2019). https://doi.org/10.5603/GP.2019.0028.

    Article  PubMed  Google Scholar 

  4. M.A. Martínez-Brocca, Benefits of continuous subcutaneous insulin infusion in type 1 diabetes. Is there any doubt? Endocrinol Nutr. 63(3), 103–105 (2016). https://doi.org/10.1016/j.endonu.2015.11.006.

    Article  PubMed  Google Scholar 

  5. J.C. Pickup, A.J. Sutton, Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet. Med. 25(7), 765–774 (2008). https://doi.org/10.1111/j.1464-5491.2008.02486.x.

    Article  CAS  PubMed  Google Scholar 

  6. J. Pickup, M. Mattock, S. Kerry, Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ 324(7339), 705 (2002). https://doi.org/10.1136/bmj.324.7339.705.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. J.C. Summers, E.M. Briganti, Z.A. Fitzgerald, L.N.J. Lambers, N.D. Cohen, Long-Term Effectiveness of Continuous Subcutaneous Insulin Infusion in the Prevention of Hypoglycemia in Adults with Type 1 Diabetes. Diabetes Technol. Ther. 21(8), 423–429 (2019). https://doi.org/10.1089/dia.2019.0108.

    Article  CAS  PubMed  Google Scholar 

  8. P. Beato-Víbora, E. Yeoh, H. Rogers, D. Hopkins, S.A. Amiel, P. Choudhary, Sustained benefit of continuous subcutaneous insulin infusion on glycaemic control and hypoglycaemia in adults with Type 1 diabetes. Diabet. Med. 32(11), 1453–1459 (2015). https://doi.org/10.1111/dme.12869.

    Article  PubMed  Google Scholar 

  9. S.M. Blackman, D. Raghinaru, S. Adi et al. Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy. Pediatr. Diabetes 15(8), 564–572 (2014). https://doi.org/10.1111/pedi.12121.

    Article  CAS  PubMed  Google Scholar 

  10. J. Olsovský, M. Beránek, The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI). Vnitr. Lek. 53(6), 637–645 (2007). PMID: 17702123.

    PubMed  Google Scholar 

  11. M.I. Maiorino, G. Bellastella, O. Casciano et al. The Effects of Subcutaneous Insulin Infusion Versus Multiple Insulin Injections on Glucose Variability in Young Adults with Type 1 Diabetes: The 2-Year Follow-Up of the Observational METRO Study. Diabetes Technol. Ther. 20(2), 117–126 (2018). https://doi.org/10.1089/dia.2017.0334.

    Article  CAS  PubMed  Google Scholar 

  12. B. Simon, V. Treat, C. Marco et al. A comparison of glycaemic variability in CSII vs. MDI treated type 1 diabetic patients using CGMS. Int. J. Clin. Pract. 62(12), 1858–1863 (2008). https://doi.org/10.1111/j.1742-1241.2008.01932.x.

    Article  CAS  PubMed  Google Scholar 

  13. R. Linkeschova, M. Raoul, U. Bott, M. Berger, M. Spraul, Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet. Med. 19(9), 746–751 (2002). https://doi.org/10.1046/j.1464-5491.2002.00713.x.

    Article  CAS  PubMed  Google Scholar 

  14. M. Lozano-Serrano, J.A. García-Seco, F. García-Seco et al. Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections. Enferm. Clin. 23(3), 96–102 (2013). https://doi.org/10.1016/j.enfcli.2013.02.004.

    Article  PubMed  Google Scholar 

  15. American Diabetes Association Workgroup on Hypoglycemia, Defining and Reporting Hypoglycemia in Diabetes. Diabetes Care 28(5), 1245–1249 (2005). https://doi.org/10.2337/diacare.28.5.1245.

    Article  Google Scholar 

  16. NICE. Type 1 diabetes in adults: diagnosis and management. https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#hypoglycaemia-awareness-and-management (2015). Accessed 01 July 2021.

  17. L.S. Radloff, The CES-D scale: A self report depression scale for research in the general population. Appl. Psychol. Measurements. 1, 385–401. (1977) https://doi.org/10.1177/014662167700100306.

  18. C.W. Topp, S.D. Østergaard, S. Søndergaard, P. Bech, The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom 84(3), 167–176 (2015). https://doi.org/10.1159/000376585.

    Article  PubMed  Google Scholar 

  19. Danne T., Nimri R., Battelino T., et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care 40(12), 1631–1640. https://doi.org/10.2337/dc17-1600.

  20. NICE. Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. https://www.nice.org.uk/guidance/ta151/chapter/1-Guidance (2008). Accessed 1 July 2021.

  21. I. Martín-Timón, F.J. Del Cañizo-Gómez, Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes 6(7), 912–926 (2015). https://doi.org/10.4239/wjd.v6.i7.912.

    Article  PubMed  PubMed Central  Google Scholar 

  22. M. Visser, S. Charleer, S. Fieuws, et al. Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial. Lancet. 2021. https://doi.org/10.1016/S0140-6736(21)00789-3.

Download references

Acknowledgements

The authors would like to thank the staff of the Division of Diabetology, Department of Endocrinology, Medical University of Sofia, for their assistance.

Author information

Authors and Affiliations

  1. Division of Diabetology, Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

    Polina Tsarkova, Nevena Chakarova, Rumyana Dimova, Greta Grozeva, Ani Todorova, Mina Serdarova, Martina Salkova & Tsvetalina Tankova

Authors
  1. Polina Tsarkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nevena Chakarova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rumyana Dimova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Greta Grozeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ani Todorova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mina Serdarova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martina Salkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tsvetalina Tankova
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by P.T., N.C., R.D., A.T., M.Se., and M.Sa. P.T., R.D., and N.C. were responsible for statistical analysis, data interpretation and drafting of the manuscript. T.T. performed critical revision of the manuscript.

Corresponding author

Correspondence to Polina Tsarkova.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval

All participants signed informed consent for participation in the study in accordance with the Helsinki Declaration and rules of Good Clinical Practice, as the study was approved by the Ethics Committee of the Medical University of Sofia.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsarkova, P., Chakarova, N., Dimova, R. et al. CSII is related to more stable glycemia in adults with type 1 diabetes. Endocrine 75, 776–780 (2022). https://doi.org/10.1007/s12020-021-02913-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-021-02913-9

Keywords

Search

Navigation