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Improved A1C by switching to continuous subcutaneous insulin infusion from injection insulin therapy in type 2 diabetes: A retrospective claims analysis

Published:September 14, 2010DOI:https://doi.org/10.1016/j.pcd.2010.07.004

      Abstract

      Aims

      This study was a real-world, retrospective evaluation of the clinical effectiveness of switching to continuous subcutaneous insulin infusion (CSII) among managed care enrollees with type 2 diabetes for whom multiple daily injections (MDI) had presumably failed.

      Methods

      Administrative claims with integrated A1C values from a large and geographically diverse health plan were analyzed.

      Results

      Statistically significant A1C reductions (from the baseline period to follow-up period, mean follow-up 17 months) were achieved with CSII. Among subjects using a long-acting and rapid-acting insulin regimen at baseline, A1C decreased to mean follow-up A1C by 0.8% and to minimum follow-up A1C by 1.2% (p < 0.001). The proportion of subjects at target (A1C < 7%) increased significantly from baseline to follow-up (8.4–22.9% [using mean A1C] and 32.8% [using minimum A1C]; both p < 0.001). The rate of severe hypoglycemic events was similar from baseline to follow-up.

      Conclusions

      CSII was associated with significant reductions in A1C without an increase in hypoglycemic events in insulin-taking people with type 2 diabetes, including subjects previously using a long-acting and rapid-acting insulin regimen.

      Keywords

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      References

        • Pickup J.C.
        • Renard E.
        Long-acting insulin analogs versus insulin pump therapy for the treatment of type 1 and type 2 diabetes.
        Diabetes Care. 2008; 31: S140-S145
        • Fatourechi M.M.
        • Kudva Y.C.
        • Murad M.H.
        • et al.
        Clinical review: hypoglycemia with intensive insulin therapy: a systematic review and meta-analyses of randomized trials of continuous subcutaneous insulin infusion versus multiple daily injections.
        J. Clin. Endocrinol. Metab. 2009; 94: 729-740
        • Monami M.
        • Lamanna C.
        • Marchionni N.
        • Mannucci E.
        Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes: a meta-analysis.
        Exp. Clin. Endocrinol. Diabetes. 2009; 117: 220-222
        • Jeitler K.
        • Horvath K.
        • Berghold A.
        • et al.
        Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis.
        Diabetologia. 2008; 51: 941-951
        • Herman W.H.
        • Ilag L.L.
        • Johnson S.L.
        • et al.
        A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes.
        Diabetes Care. 2005; 28: 1568-1573
        • Raskin P.
        • Bode B.W.
        • Marks J.B.
        • et al.
        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
        • Wainstein J
        • Metzger M.
        • Boaz M.
        • et al.
        Insulin pump therapy vs. multiple daily injections in obese type 2 diabetic patients.
        Diabet. Med. 2005; 22: 1037-1046
        • Weng J.
        • Li Y.
        • Xu W.
        • et al.
        Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial.
        Lancet. 2008; 371: 1753-1760
        • Berthe E.
        • Lireux B.
        • Coffin C.
        • et al.
        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.
        Horm. Metab. Res. 2007; 39: 224-229
        • Janka H.U.
        • Plewe G.
        • Busch K.
        Combination of oral antidiabetic agents with basal insulin versus premixed insulin alone in randomized elderly patients with type 2 diabetes mellitus.
        J. Am. Geriatr. Soc. 2007; 55: 182-188
        • Bartley P.C.
        • Bogoev M.
        • Larsen J.
        • Philotheou A.
        Long-term efficacy and safety of insulin detemir compared to neutral protamine gagedorn insulin in patients with type 1 diabetes using a treat-to-target basal-bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial.
        Diabet. Med. 2008; 25: 442-449
        • Janka H.U.
        • Plewe G.
        • Riddle M.C.
        • et al.
        Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes.
        Diabetes Care. 2005; 28: 254-259
        • Labrousse-Lhermine F.
        • Cazals L.
        • Ruidavets J.B.
        • Hanaire H.
        Long-term treatment combining continuous subcutaneous insulin infusion with oral hypoglycaemic agents is effective in type 2 diabetes.
        Diabet. Metab. 2007; 33: 253-260
        • American Diabetes Association
        Standards of medical care in diabetes—2010.
        Diabetes Care. 2009; 33: S11-S61
        • The Diabetes Control and Complications Trial Research Group
        The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
        N. Engl. J. Med. 1993; 329: 977-986
        • The DCCT Research Group
        Epidemiology of severe hypoglycemia in the diabetes control and complications trial.
        Am. J. Med. 1991; 90: 450-459