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Two Popular Treatments of Insulin Are On Par
In the July 2005 issue of Diabetes Care, a group of researchers published their findings on the efficacy of continuous subcutaneous insulin infusion (CSII) and multiple day injection (MDI). Both CSII and MDI are methods of treating Type 2 Diabetes and were found to be equally safe and satisfactory in this latest study. The researchers, Dr. William H. Herman of the University of Michigan Health System and his colleagues, discovered that although both methods can be effective in maintaining glycemic control, they have not been evaluated for their effect in older type 2 diabetic patients.
CSII devices are external pumps consisting of a programmable pump with an electronic gauge and an insulin storage reservoir which the patient is connected to at all times. Insulin is administered to the patient via a needle or cannula. The pump continuously delivers insulin at a rate (constant or varying on a case-by-case basis) with an additional boost dose delivered at meals. Advances in technology have lead to smaller and more reliable pumps than earlier models. MDI is an older treatment that includes several injections of insulin each day in order to balance sugar levels in the bloodstream. These injections are usually synthetic insulins.
To do so, the researchers studied 107 patients (mean age of 66 years) with Type 2 diabetes and required insulin. They were randomized to the CSII treatment with insulin lispro or MDI with insulin lispro and insulin glargine. Insulin lispro (product name: Humalog) is an insulin analog that was approved by the FDA in 1996. Insulin glargine (product name: Lantus) is another type of long acting synthetic insulin. After 12 months of the treatments, hemoglobin A1C levels were not significantly different between groups. Tests for A1C, also known as glycated hemoglobin or glycosylated hemoglobin, determine a patient's blood sugar control over a period of months. The mean level fell by 1.7% to 6.6% in the CSII group as compared to the 1.6% to 6.4% drop in the MDI group. Overall, 81% of CSII patients and 90% of MDI patients experienced at least one episode of minor and self-treated hypoglycemia. There were 3 CSII subjects who experienced episodes of severe hypoglycemia compared with 6 MDI subjects; the difference was not significant however.
Treatment satisfaction improved significantly groups to the same extent. The researchers conclude that both methods, "achieved excellent glycemic control with good safety and patient satisfaction."
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