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A Clinical Trial of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Older Adults With Type 2 Diabetes

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Herman, William H., Ilag, Liza L., Johnson, Susan L., Martin, Catherine L., Sinding, Joyce, Al Harthi, Abdulaziz, Plunkett, Cynthia D., LaPorte, Frankie B. +4 more·2005·Diabetes Care
DOI 10.2337/diacare.28.7.1568
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Abstract

OBJECTIVE—To compare the efficacy and safety of continuous subcutaneous insulin infusion (CSII) and multiple daily injection (MDI) in older adults with insulin-treated type 2 diabetes and to assess treatment satisfaction and quality of life. RESEARCH DESIGN AND METHODS—Adults (n = 107) ≥60 years of age (mean age 66 years) with insulin-treated type 2 diabetes (mean duration 16 years, BMI 32 kg/m2, and HbA1C [A1C] 8.2%) were randomized to CSII (using insulin lispro) or MDI (using insulin lispro and insulin glargine) in a two-center, 12-month, prospective, randomized, controlled clinical trial. Efficacy was assessed with A1C, safety by frequency of hypoglycemia, and treatment satisfaction and quality of life with the Diabetes Quality of Life Clinical Trial Questionnaire and the 36-item short-form health survey, version 2. RESULTS—Forty-eight CSII subjects (91%) and 50 MDI subjects (93%) completed the study. Mean A1C fell by 1.7 ± 1.0% in the CSII group to 6.6% and by 1.6 ± 1.2% in the MDI group to 6.4%. The difference in A1C between treatment groups was not statistically significant (P = 0.20). Eighty-one percent of CSII subjects and 90% of MDI subjects experienced at least one episode of minor (self-treated) hypoglycemia (P = 0.17), and three CSII and six MDI subjects experienced severe hypoglycemia (P = 0.49). Rates of severe hypoglycemia were similarly low in the two groups (CSII 0.08 and MDI 0.23 events per person-year, P = 0.61). Weight gain did not differ between groups (P = 0.70). Treatment satisfaction improved significantly with both CSII and MDI (P < 0.0001), and the difference between groups was not statistically significant (P = 0.58). CONCLUSIONS—In older subjects with insulin-treated type 2 diabetes, both CSII and MDI achieved excellent glycemic control with good safety and patient satisfaction.

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  • A mean A1C of 7% was achieved and maintained for 12 months with either an insulin pump regimen or multiple daily insulin injections in otherwise healthy and functional older adults (mean age 66 years), with low rates of hypoglycemia.

    “A mean A1C of 7% was achieved and maintained for 12 months with either an insulin pump regimen or multiple daily insulin injections in otherwise healthy and functional older adults (mean age 66 years), with low rates of hypoglycemia99.”

    From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [99]

  • Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients.

    “Insulin therapy can be used to achieve glycemic goals in selected older adults with type 2 diabetes with similar efficacy and hypoglycemia risk as in younger patients.”

    From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [99]

  • A 12-month prospective randomized study in 107 adults with insulin-treated type 2 diabetes showed no significant difference between CSII and multiple dose insulin in the rates of mild or severe hypoglycemia.

    “A 12-month prospective randomized study in 107 adults with insulin-treated type 2 diabetes showed no significant difference between CSII and multiple dose insulin in the rates of mild or severe hypoglycemia (142).”

    From Hypoglycemia in Type 2 Diabetes (2005) · cites this paper as [142]

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Authors
Herman, W. H., Ilag, L. L., Johnson, S. L., Martin, C. L., Sinding, J., Al Harthi, A., Plunkett, C. D., LaPorte, F. B., Burke, R., Brown, M. B., Halter, J. B., & Raskin, P.
Affiliations
  • University of Michigan (US)
  • The University of Texas Southwestern Medical Center (US)
  • Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2005-07-01
Volume
28
Issue
7
Pages
1568-1573
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.28.7.1568
OpenAlex
W2135131610
Cited by
265
References
23
Citations by year
2025: 3 · 2024: 6 · 2023: 8 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 11 · 2018: 12 · 2017: 13 · 2016: 16 · 2015: 21 · 2014: 15 · 2013: 15 · 2012: 15
FWCI
12.07
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • University of Michigan
  • National Institute of Diabetes and Digestive and Kidney Diseases (5P60DK-20572, P60DK020572)
  • National Center for Research Resources (M-01RR00042, M01RR000042)
  • NIH Clinical Center
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
insulin pump therapy, multiple daily insulin injections, type 2 diabetes, older adults, insulin-treated diabetes, glycemic control, HbA1c, hypoglycemia, insulin lispro, insulin glargine, treatment satisfaction, quality of life, weight gain
MeSH terms
Diabetes Mellitus, Type 2, Drug Administration Schedule, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Injections, Subcutaneous, Insulin, Insulin Infusion Systems, Middle Aged, Quality of Life, Surveys and Questionnaires, Weight Gain, Patient Satisfaction

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