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Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability.
Diabetes Metab Res Rev. 2006 May-Jun; 22(3):232-7.DM

Abstract

BACKGROUND AND METHODS

We investigated the factors that determine the best glycaemic control on multiple daily insulin (MDI) injections and continuous subcutaneous insulin infusion (CSII), and the hypothesis that blood glucose variability is a major determinant of control and that the resultant HbA(1c) on MDI correlates with the improvement achieved by CSII. We studied 30 type 1 diabetic subjects already receiving MDI. Renewed attempts to improve control on MDI were made for a median of five months, and then the subjects were switched to CSII. The variability of within-day and between-day blood glucose concentrations was calculated from blood glucose self-monitoring data.

RESULTS

HbA(1c) during MDI varied from 5.7 to 11.7% (mean +/- SD, 8.5 +/- 1.4%). Within- and between-day blood glucose variability correlated with HbA(1c) on MDI (r = 0.59, p < 0.001; r = 0.48, p < 0.03). Within-day variability remained an independent predictor of HbA(1c) on MDI. Mean HbA(1c) improved with CSII (to 7.3 +/- 0.9%, p < 0.001), but reduction in HbA(1c) was variable and was related to the HbA(1c) on MDI (r = 0.79, p < 0.001) and within-day variability (r = 0.56, p < 0.01). Similar results were observed for subjects treated only with glargine-based MDI.

CONCLUSIONS

The best glycaemic control achievable on MDI is related to blood glucose variability-those with the largest swings in blood glucose retaining the highest HbA(1c). The improvement in control achieved by CSII is related to HbA(1c) and blood glucose variability on MDI. Pump therapy is most effective in those worst controlled on MDI.

Authors+Show Affiliations

Metabolic Unit, King's College London School of Medicine, Guy's Hospital, London, UK. john.pickup@kcl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16389648

Citation

Pickup, John C., et al. "Determinants of Glycaemic Control in Type 1 Diabetes During Intensified Therapy With Multiple Daily Insulin Injections or Continuous Subcutaneous Insulin Infusion: Importance of Blood Glucose Variability." Diabetes/metabolism Research and Reviews, vol. 22, no. 3, 2006, pp. 232-7.
Pickup JC, Kidd J, Burmiston S, et al. Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability. Diabetes Metab Res Rev. 2006;22(3):232-7.
Pickup, J. C., Kidd, J., Burmiston, S., & Yemane, N. (2006). Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability. Diabetes/metabolism Research and Reviews, 22(3), 232-7.
Pickup JC, et al. Determinants of Glycaemic Control in Type 1 Diabetes During Intensified Therapy With Multiple Daily Insulin Injections or Continuous Subcutaneous Insulin Infusion: Importance of Blood Glucose Variability. Diabetes Metab Res Rev. 2006 May-Jun;22(3):232-7. PubMed PMID: 16389648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability. AU - Pickup,John C, AU - Kidd,Julia, AU - Burmiston,Sheila, AU - Yemane,Nardos, PY - 2006/1/4/pubmed PY - 2006/8/17/medline PY - 2006/1/4/entrez SP - 232 EP - 7 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab Res Rev VL - 22 IS - 3 N2 - BACKGROUND AND METHODS: We investigated the factors that determine the best glycaemic control on multiple daily insulin (MDI) injections and continuous subcutaneous insulin infusion (CSII), and the hypothesis that blood glucose variability is a major determinant of control and that the resultant HbA(1c) on MDI correlates with the improvement achieved by CSII. We studied 30 type 1 diabetic subjects already receiving MDI. Renewed attempts to improve control on MDI were made for a median of five months, and then the subjects were switched to CSII. The variability of within-day and between-day blood glucose concentrations was calculated from blood glucose self-monitoring data. RESULTS: HbA(1c) during MDI varied from 5.7 to 11.7% (mean +/- SD, 8.5 +/- 1.4%). Within- and between-day blood glucose variability correlated with HbA(1c) on MDI (r = 0.59, p < 0.001; r = 0.48, p < 0.03). Within-day variability remained an independent predictor of HbA(1c) on MDI. Mean HbA(1c) improved with CSII (to 7.3 +/- 0.9%, p < 0.001), but reduction in HbA(1c) was variable and was related to the HbA(1c) on MDI (r = 0.79, p < 0.001) and within-day variability (r = 0.56, p < 0.01). Similar results were observed for subjects treated only with glargine-based MDI. CONCLUSIONS: The best glycaemic control achievable on MDI is related to blood glucose variability-those with the largest swings in blood glucose retaining the highest HbA(1c). The improvement in control achieved by CSII is related to HbA(1c) and blood glucose variability on MDI. Pump therapy is most effective in those worst controlled on MDI. SN - 1520-7552 UR - https://www.unboundmedicine.com/medline/citation/16389648/Determinants_of_glycaemic_control_in_type_1_diabetes_during_intensified_therapy_with_multiple_daily_insulin_injections_or_continuous_subcutaneous_insulin_infusion:_importance_of_blood_glucose_variability_ L2 - https://doi.org/10.1002/dmrr.614 DB - PRIME DP - Unbound Medicine ER -