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IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, AND TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED TO MULTIPLE DAILY INSULIN INJECTIONS IN PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE OF BASELINE C-PEPTIDE LEVELS.
Endocr Pract. 2018 May; 24(5):446-452.EP

Abstract

OBJECTIVE

Fasting C-peptide levels are used to differentiate type 1 from type 2 diabetes (T2D), thereby determining eligibility for coverage of continuous subcutaneous insulin infusion (CSII) for patients with T2D.

METHODS

A total of 168 patients (74 female/94 male, aged 55.5 ± 9.7 years) were randomized to CSII, and 163 patients (77 female/86 male, aged 56.4 ± 9.5 years) were randomized to multiple daily injections (MDI) of insulin and grouped by baseline C-peptide level: group A (≤183 pmol/L [≤0.55 ng/mL]); group B (>183 pmol/L [>0.55 ng/mL]). At 6 months, the MDI group crossed over to CSII. Within- and between-group comparisons were recorded at 6 and 12 months in the entire group and separately for those patients aged ≥65 years.

RESULTS

CSII reduced hemoglobin A1c (A1c) equally in groups A ( P = .0006, P = .0022) and B ( P<.0001, P<.0001) at 6 and 12 months, respectively. There was an increase in weight in group A versus group B at 6 months but not 12 months ( P<.03). CSII therapy reduced total daily dose (TDD) of insulin and improved treatment satisfaction similarly in groups A and B. The results for patients aged ≥65 years displayed a similar trend as the entire group.

CONCLUSION

A1c, TDD of insulin, and treatment satisfaction improved for T2D patients using CSII versus MDI therapy, irrespective of baseline C-peptide level. A subgroup of patients aged ≥65 years displayed a similar trend. These results support abandoning C-peptide as a criterion for reimbursing CSII therapy in patients with diabetes.

ABBREVIATIONS

A1c = hemoglobin A1c; CMS = Centers for Medicare and Medicaid Services; CSII = continuous subcutaneous insulin infusion; DTSQ = Diabetes Treatment Satisfaction Questionnaire; MDI = multiple daily injections; RCT = randomized controlled trials; T1D = type 1 diabetes; T2D = type 2 diabetes; TDD = total daily dose.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29847166

Citation

Vigersky, Robert A., et al. "IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, and TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED to MULTIPLE DAILY INSULIN INJECTIONS in PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE of BASELINE C-PEPTIDE LEVELS." Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 24, no. 5, 2018, pp. 446-452.
Vigersky RA, Huang S, Cordero TL, et al. IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, AND TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED TO MULTIPLE DAILY INSULIN INJECTIONS IN PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE OF BASELINE C-PEPTIDE LEVELS. Endocr Pract. 2018;24(5):446-452.
Vigersky, R. A., Huang, S., Cordero, T. L., Shin, J., Lee, S. W., Chhabra, H., Kaufman, F. R., & Cohen, O. (2018). IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, AND TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED TO MULTIPLE DAILY INSULIN INJECTIONS IN PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE OF BASELINE C-PEPTIDE LEVELS. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 24(5), 446-452. https://doi.org/10.4158/EP-2017-0234
Vigersky RA, et al. IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, and TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED to MULTIPLE DAILY INSULIN INJECTIONS in PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE of BASELINE C-PEPTIDE LEVELS. Endocr Pract. 2018;24(5):446-452. PubMed PMID: 29847166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - IMPROVED HBA1C, TOTAL DAILY INSULIN DOSE, AND TREATMENT SATISFACTION WITH INSULIN PUMP THERAPY COMPARED TO MULTIPLE DAILY INSULIN INJECTIONS IN PATIENTS WITH TYPE 2 DIABETES IRRESPECTIVE OF BASELINE C-PEPTIDE LEVELS. AU - Vigersky,Robert A, AU - Huang,Suiying, AU - Cordero,Toni L, AU - Shin,John, AU - Lee,Scott W, AU - Chhabra,Harmeet, AU - Kaufman,Francine R, AU - Cohen,Ohad, AU - ,, PY - 2018/5/31/entrez PY - 2018/5/31/pubmed PY - 2018/9/12/medline SP - 446 EP - 452 JF - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists JO - Endocr Pract VL - 24 IS - 5 N2 - OBJECTIVE: Fasting C-peptide levels are used to differentiate type 1 from type 2 diabetes (T2D), thereby determining eligibility for coverage of continuous subcutaneous insulin infusion (CSII) for patients with T2D. METHODS: A total of 168 patients (74 female/94 male, aged 55.5 ± 9.7 years) were randomized to CSII, and 163 patients (77 female/86 male, aged 56.4 ± 9.5 years) were randomized to multiple daily injections (MDI) of insulin and grouped by baseline C-peptide level: group A (≤183 pmol/L [≤0.55 ng/mL]); group B (>183 pmol/L [>0.55 ng/mL]). At 6 months, the MDI group crossed over to CSII. Within- and between-group comparisons were recorded at 6 and 12 months in the entire group and separately for those patients aged ≥65 years. RESULTS: CSII reduced hemoglobin A1c (A1c) equally in groups A ( P = .0006, P = .0022) and B ( P<.0001, P<.0001) at 6 and 12 months, respectively. There was an increase in weight in group A versus group B at 6 months but not 12 months ( P<.03). CSII therapy reduced total daily dose (TDD) of insulin and improved treatment satisfaction similarly in groups A and B. The results for patients aged ≥65 years displayed a similar trend as the entire group. CONCLUSION: A1c, TDD of insulin, and treatment satisfaction improved for T2D patients using CSII versus MDI therapy, irrespective of baseline C-peptide level. A subgroup of patients aged ≥65 years displayed a similar trend. These results support abandoning C-peptide as a criterion for reimbursing CSII therapy in patients with diabetes. ABBREVIATIONS: A1c = hemoglobin A1c; CMS = Centers for Medicare and Medicaid Services; CSII = continuous subcutaneous insulin infusion; DTSQ = Diabetes Treatment Satisfaction Questionnaire; MDI = multiple daily injections; RCT = randomized controlled trials; T1D = type 1 diabetes; T2D = type 2 diabetes; TDD = total daily dose. SN - 1530-891X UR - https://www.unboundmedicine.com/medline/citation/29847166/IMPROVED_HBA1C_TOTAL_DAILY_INSULIN_DOSE_AND_TREATMENT_SATISFACTION_WITH_INSULIN_PUMP_THERAPY_COMPARED_TO_MULTIPLE_DAILY_INSULIN_INJECTIONS_IN_PATIENTS_WITH_TYPE_2_DIABETES_IRRESPECTIVE_OF_BASELINE_C_PEPTIDE_LEVELS_ DB - PRIME DP - Unbound Medicine ER -