Comparison of a Multiple Daily Insulin Injection Regimen (Basal Once-Daily Glargine Plus Mealtime Lispro) and Continuous Subcutaneous Insulin Infusion (Lispro) in Type 1 Diabetes
Open accessAbstract
OBJECTIVE: Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) and multiple daily injections (MDIs) with insulin glargine as basal insulin and mealtime insulin lispro have not been prospectively compared in people naïve to either regimen in a multicenter study. We aimed to help close that deficiency. RESEARCH DESIGN AND METHODS: People with type 1 diabetes on NPH-based insulin therapy were randomized to CSII or glargine-based MDI (both otherwise using lispro) and followed for 24 weeks in an equivalence design. Fifty people were correctly randomized, and 43 completed the study. RESULTS: Total insulin requirement (mean ± SD) at end point was 36.2 ± 11.5 units/day on CSII and 42.6 ± 15.5 units/day on MDI. Mean A1C fell similarly in the two groups (CSII −0.7 ± 0.7%; MDI −0.6 ± 0.8%) with a baseline-adjusted difference of −0.1% (95% CI −0.5 to 0.3). Similarly, fasting blood glucose and other preprandial, postprandial, and nighttime self-monitored plasma glucose levels did not differ between the regimens, nor did measures of plasma glucose variability. On CSII, 1,152 hypoglycemia events were recorded by 23 of 28 participants (82%) and 1,022 in the MDI group by 27 of 29 patients (93%) (all hypoglycemia differences were nonsignificant). Treatment satisfaction score increased more with CSII; however, the change in score was similar for the groups. Costs were ∼3.9 times higher for CSII. CONCLUSIONS: In unselected people with type 1 diabetes naïve to CSII or insulin glargine, glycemic control is no better with the more expensive CSII therapy compared with glargine-based MDI therapy.
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Insulin pump therapy reduces the rate of severe hypoglycemia.
“reduces the rate of severe hypoglycemia”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [3]
The Results (Hypoglycemia) report one severe hypoglycemic event in each of two participants in both the pump (CSII) and injection (MDI) groups, not a lower rate with pump therapy. The Conclusions likewise describe similar hypoglycemia outcomes for the two regimens. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredInsulin pump therapy has potential advantages compared with multiple daily injections, including improved glycemic control, reduced rate of severe hypoglycemia, greater flexibility, and higher quality of life.
“Potential advantages of insulin pump therapy compared with MDI include improved glycemic control, reduced rate of severe hypoglycemia, greater flexibility, and higher quality of life.2–6”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [3]
The introduction reports earlier studies finding better A1C control and less hypoglycemia with pump therapy, while limiting a proposed benefit for severe hypoglycemia to selected people with recurrent episodes on NPH-based injections. This study’s Results found similar glycemic control and severe-hypoglycemia events with the two regimens. Treatment satisfaction favored pumps on one measure, but the copy does not establish greater flexibility or higher quality of life. (LLM, conf=0.88)
Experimental — accuracy not yet measuredInsulin pump therapy is associated with greater quality of life.
“is associated with greater quality of life.2–6”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [3]
The Results (Treatment satisfaction; page unavailable) report a higher treatment-satisfaction score at 24 weeks with pump therapy than with multiple daily injections. The study measured treatment satisfaction, not quality of life, and found that the change in satisfaction score did not differ significantly between groups. It therefore supports a narrower claim than the one cited. (LLM, conf=0.83)
Experimental — accuracy not yet measuredInsulin pump therapy may improve glycemic control.
“insulin pump therapy may improve glycemic control”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [3]
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Facteurs prédictifs d’amélioration glycémique chez les patients diabétiques sous pompe à insuline
Saatdjian-Salino, L. (2013) · HAL
- Authors
- Bolli, G. B., Kerr, D., Thomas, R., Torlone, E., Sola-Gazagnes, A., Vitacolonna, E., Selam, J. L., & Home, P. D.
- Affiliations
- University of Perugia (IT)
- Royal Bournemouth Hospital (GB)
- Newcastle University (GB)
- Service de Diabétologie, Hôtel Dieu, APHP, Paris, France;
- University of Chieti-Pescara (IT)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Bolli, Geremia B.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-04-23
- Volume
- 32
- Issue
- 7
- Pages
- 1170-1176
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2699706
- OpenAlex
- W2142372141
- Cited by
- 119
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 5 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 10 · 2015: 9 · 2014: 6 · 2013: 9 · 2012: 13
- FWCI
- 10.44
- Type
- journal article
- Language
- en
- Update notices
- correction (2009-10-01)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, insulin pump therapy, multiple daily insulin injections, insulin glargine, insulin lispro, basal insulin, glycemic control, hypoglycemia, insulin requirement, glycemic variability, treatment satisfaction, cost comparison
- MeSH terms
- Insulin Glargine, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Drug Administration Schedule, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Injections, Subcutaneous, Insulin, Insulin Infusion Systems, Kinetics, Male, Middle Aged, Age of Onset, Insulin, Long-Acting, Insulin Lispro
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