TY - JOUR T1 - Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study. AU - Ruiz-de-Adana,María Soledad, AU - Dominguez-Lopez,Marta-Elena, AU - Gonzalez-Molero,Inmaculada, AU - Machado,Alberto, AU - Martin,Victor, AU - Cardona,Isabel, AU - de-la-Higuera,Magdalena, AU - Tapia,María-José, AU - Soriguer,Federico, AU - Anarte,María Teresa, AU - Rojo-Martínez,Gemma, Y1 - 2015/12/04/ PY - 2015/05/26/received PY - 2015/08/25/revised PY - 2015/09/03/accepted PY - 2015/12/15/entrez PY - 2015/12/15/pubmed PY - 2016/12/24/medline KW - CSII KW - Diabetes tipo 1 KW - ISCI KW - MDI KW - Type 1 diabetes SP - 239 EP - 46 JF - Medicina clinica JO - Med Clin (Barc) VL - 146 IS - 6 N2 - BACKGROUND AND OBJECTIVE: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). METHODS: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. RESULTS: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p<0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p<0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p<0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p<0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p<0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p<0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p<0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p<0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p<0.03). CONCLUSIONS: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes. SN - 1578-8989 UR - https://www.unboundmedicine.com/medline/citation/26656958/Comparison_between_a_multiple_daily_insulin_injection_regimen__basal_once_daily_glargine_plus_mealtime_lispro__and_continuous_subcutaneous_insulin_infusion__lispro__using_continuous_glucose_monitoring_in_metabolically_optimized_type_1_diabetes_patients:_A_randomized_open_labelled_parallel_study_ DB - PRIME DP - Unbound Medicine ER -