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Reduction in Severe Hypoglycemia With Long-Term Continuous Subcutaneous Insulin Infusion in Type I Diabetes

Bode, Bruce W, Steed, R Dennis, Davidson, Paul C·1996·Diabetes Care

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Abstract

Objective To compare the incidence of severe hypoglycemia in patients crossed over from multiple daily injections (MDIs) of insulin to continuous subcutaneous insulin infusion (CSII). Research design and methods From a population of 225 patients using CSII, all patients who met the following selection criteria were included in the present study: 1) a minimum of 12 months on intensive therapy with MDIs before switching to CSII, and 2) a minimum of 12 months on CSII after crossover. Glycemic control and adverse event rates for the 1-year MDI control period were compared with those for the CSII therapy period. Results The incidence of severe hypoglycemia during MDI therapy declined from 138 to 22 events per 100 patient-years during the 1st year of CSII (P or = 8.0%, the change to CSII was associated with a significant reduction in HbA1c from baseline to year 1 (8.9 +/- 0.8 vs. 8.1 +/- 1.0%, P = 0.0004). The difference in diabetic ketoacidosis rates between the MDI year (14.6 events per 100 patient-years) and the CSII period (7.2 events per 100 patient-years) was not statistically significant. Conclusions CSII therapy was associated with a marked and sustained reduction in the rate of severe hypoglycemia without adversely affecting the level of glycemic control attained during MDI therapy. The more reproducible and flexible insulin delivery afforded by CSII was considered to be the major factor contributing to the improvement in severe hypoglycemia rates.

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Current status and future prospects of parenteral insulin regimens, strategies and delivery systems for diabetes treatment1Abbreviations: AIA, antiinsulin antibody; CAPD, continuous ambulatory dialysis; CSII, continuous subcutaneous insulin infusion; DCCT, diabetes control complications trial; FIR, far infrared radiation; GLP1, glucagon-like peptide 1; GH, growth hormone; HbA1c, glycated hemoglobin; IDDM, insulin-dependent diabetes mellitus; IGF1, insulin-like growth factor 1; i.p., intraperitoneal; ISF, interstitial fluid; ISGIID, International Study Group on Implantable Insulin Delivery Devices; i.v., intravenous; MDI, multiple daily injections; NIDDM, non-insulin-dependent diabetes mellitus; PAI1, plasminogen activator inhibitor 1; rh IGF1, recombinant human insulin-like growth factor 1; SHBG, sex hormone binding globulin; SC, subcutaneous; SMBG, self monitoring of blood glucose; TG, triglycerides.1
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Authors: Bode, B. W., Steed, R. D., & Davidson, P. C.
Affiliations: Atlanta Diabetes Associates (US)
ORCID: Bode, Bruce W
Steed, R Dennis
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 1996-04-01
Volume: 19
Issue: 4
Pages: 324-327
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.19.4.324
OpenAlex: W1989943003
Cited by: 257
References: 0
Citations by year: 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 7 · 2019: 2 · 2018: 6 · 2017: 7 · 2016: 5 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 9
FWCI: 2.62
Type: journal article
Language: en
Open access: closed
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: severe hypoglycemia, insulin pump therapy, type 1 diabetes, multiple daily insulin injections, insulin delivery, glycemic control, HbA1c, diabetic ketoacidosis, intensive insulin therapy
MeSH terms: Adult, Algorithms, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Insulin, Insulin Infusion Systems, Male, Time Factors, Blood Glucose Self-Monitoring, Incidence, Diabetic Ketoacidosis, Patient Selection, Cross-Over Studies

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Reduction in Severe Hypoglycemia With Long-Term Continuous Subcutaneous Insulin Infusion in Type I Diabetes

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