Horm Metab Res 2007; 39(3): 224-229
DOI: 10.1055/s-2007-970423
Original Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Effectiveness of Intensive Insulin Therapy by Multiple Daily Injections and Continuous Subcutaneous Infusion: A Comparison Study in Type 2 Diabetes with Conventional Insulin Regimen Failure

E. Berthe 1 , B. Lireux 1 , C. Coffin 1 , B. Goulet-Salmon 2 , D. Houlbert 2 , S. Boutreux 3 , S. Fradin 4 , Y. Reznik 1
  • 1Division of Endocrinology and Metabolic Diseases, Caen University Hospital, France
  • 2Department of Endocrinology and Diabetes, Alençon Hospital, France
  • 3Division of Statistics and Public Health, Caen University Hospital, France
  • 4Division of Biochemistry, Caen University Hospital, France
Further Information

Publication History

received 13. 3. 2006

accepted 16. 10. 2006

Publication Date:
20 March 2007 (online)

Abstract

Objective: To compare the effectiveness of two intensified insulin regimens, i.e., pump delivery versus multiple daily injections in patients with type 2 diabetes not optimally controlled with conventional insulin therapy.

Research design and methods: Seventeen type 2 diabetes patients uncontrolled by two daily injections of regular plus NPH were randomly assigned in a cross-over fashion to either three daily injections of lispro plus NPH or pump device delivering lispro. HbA1c, 6 points capillary blood glucose, 24-hour continuous glucose monitoring system tracings and global satisfaction score were evaluated at the end of each 12-week treatment period.

Results: HbA1c decreased from 9.0±1.6% to 8.6±1.6% with multiple injections and 7.7±0.8% with pump device (p<0.03). Capillary blood glucose was lowered at all time-points with pump, but only at morning with multiple injections (p<0.01). Compared to conventional therapy, pump reduced hyperglycemic area under curve by 73% (p<0.01), but multiple injections by only 32% (p=0.08). Rate of hypoglycemia was not increased and patient's satisfaction was comparable with both intensive treatments.

Conclusions: Pump therapy provides a better metabolic control than injection regimens, and seems to be safe and convenient in patients with type 2 diabetes who fail to respond to conventional insulin therapy.

References

  • 1 Janka HU, Plewe G, Kliebe-Frisch C, Schweitzer MA. Starting insulin for type 2 diabetes with insulin glargine added to oral agents versus twice-daily premixed insulin alone [Abstract].  Diabetologia. 2003;  46 ((Suppl 2)) A268
  • 2 Riddle MC, Rosenstock J, Gerich J. Insulin Glargine 4002 Study Investigators: the treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients.  Diabetes Care. 2003;  26 3080-3086
  • 3 Fritsche A, Schweitzer MA, Haring HU. 4001 Study Group . Glimepiride combined with morning insulin glargine, bedtime neutral protamine hagedorn insulin, or bedtime insulin glargine in patients with type 2 diabetes. A randomized, controlled trial.  Ann Intern Med. 2003;  138 952-959
  • 4 UK Prospective Diabetes Study (UKPDS) Group . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).  Lancet. 1998;  352 837-853
  • 5 Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.  N Engl J Med. 2003;  348 383-393
  • 6 Abraira C, Colwell JA, Nuttall FQ, Sawin CT, Nagel NJ, Comstock JP, Emanuele NV, Levin SR, Henderson W, Lee HS. Veterans Affairs Cooperative Study on glycemic control and complications in type II diabetes (VA CSDM). Results of the feasibility trial. Veterans Affairs Cooperative Study in Type II Diabetes.  Diabetes Care. 1995;  18 1113-1123
  • 7 Charbonnel B, Balarac N, Cazeneuve B, Augendre-Ferrante B, Le Thai F, Drouin P. Schema survey. Which are the insulin treatment regimens used in France? The “Schema survey”.  Diabetes Metab. 2001;  27 591-597
  • 8 Implementation of treatment protocols in the Diabetes Control and Complications Trial.  Diabetes Care. 1995;  18 361-376
  • 9 Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. The Study Group for the Development of Pump Therapy in Diabetes . 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.  Diabetes Care. 2000;  23 1232-1235
  • 10 Doyle EA, Weinzimer SA, Steffen AT, Ahern JA, Vincent M, Tamborlane WV. A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine.  Diabetes Care. 2004;  27 1554-1558
  • 11 Pouwels MJ, Tack CJ, Hermus AR, Lutterman JA. Treatment with intravenous insulin followed by continuous subcutaneous insulin infusion improves glycaemic control in severely resistant Type 2 diabetic patients.  Diabet Med. 2003;  20 76-79
  • 12 Jennings AM, Lewis KS, Murdoch S, Talbot JF, Bradley C, Ward JD. Randomized trial comparing continuous subcutaneous insulin infusion and conventional insulin therapy in type II diabetic patients poorly controlled with sulfonylureas.  Diabetes Care. 1991;  14 738-744
  • 13 Raskin P, Bode BW, Marks JB, Hirsch IB, Weinstein RL, McGill JB, Peterson GE, Mudaliar SR, Reinhardt RR. Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally effective in type 2 diabetes: a randomized, parallel-group, 24-week study.  Diabetes Care. 2003;  26 2598-2603
  • 14 American Diabetes Association . Nutrition Principles and Recommendations in Diabetes (Position Statement).  Diabetes Care. 2004;  26 ((Suppl 1)) S36-S46
  • 15 Schernthaner G, Kopp HP, Ristic S, Muzyka B, Peter L, Mitteregger G. Metabolic control in patients with type 2 diabetes using Humalog Mix50 injected three times daily: crossover comparison with human insulin 30/70.  Horm Metab Res. 2004;  36 188-193
  • 16 Weintrob N, Schechter A, Benzaquen H, Shalitin S, Lilos P, Galatzer A, Phillip M. Glycemic patterns detected by continuous subcutaneous glucose sensing in children and adolescents with type 1 diabetes mellitus treated by multiple daily injections vs continuous subcutaneous insulin infusion.  Arch Pediatr Adolesc Med. 2004;  158 677-684
  • 17 Abraira C, Henderson WG, Colwell JA, Nuttall FQ, Comstock JP, Emanuele NV, Levin SR, Sawin CT, Silbert CK. Response to intensive therapy steps and to glipizide dose in combination with insulin in type 2 diabetes. VA feasibility study on glycemic control and complications (VA CSDM).  Diabetes Care. 1998;  21 574-579
  • 18 Feinglos MN, Thacker CH, English J, Bethel MA, Lane JD. Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes.  Diabetes Care. 1997;  20 1539-1542
  • 19 Bastyr 3rd EJ, Stuart CA, Brodows RG, Schwartz S, Graf CJ, Zagar A, Robertson KE. Therapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HbA1c. IOEZ Study Group.  Diabetes Care. 2000;  23 1236-1241
  • 20 Bastyr 3rd EJ, Huang Y, Brunelle RL, Vignati L, Cox DJ, Kotsanos JG. Factors associated with nocturnal hypoglycaemia among patients with type 2 diabetes new to insulin therapy: experience with insulin lispro.  Diabetes Obes Metab. 2000;  2 39-46
  • 21 Raskin P, Allen E, Hollander P, Lewin A, Gabbay RA, Hu P, Bode B, Garber A. Initiating insulin therapy in type 2 diabetes: a comparison between biphasic and basal insulin analogs.  Diabetes Care. 2005;  28 260-265
  • 22 Ilkova H, Glaser B, Tunckale A, Bagriacik N, Cerasi E. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment.  Diabetes Care. 1997;  20 1353-1356
  • 23 Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, Yerushalmy Y, Raz I, Harman-Boehm I. Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patients.  Diabet Med. 2005;  22 1037-1046

Correspondence

Y. Reznik

University of Caen · Department of Endocrinology

CHU Côte de Nacre

14033 CAEN Cedex

France

Phone: +33/231/06 45 86

Fax: +33/231/06 48 54

Email: reznik-y@chu-caen.fr

    >