A study of continuous subcutaneous insulin infusion in children with type 1 diabetes mellitus / 国际儿科学杂志

Objective:To study the effect of continuous subcutaneous insulin infusion(CSII)on the emotional disorder of children and adolescents with type 1 diabetes mellitus(T1DM)and their parents.Methods:A total of 72 children and adolescents with T1DM were divided into CSII group( n=40)and multiple daily injection(MDI)group( n=32).There were 58 healthy children and adolescents with their parents selected as control group.The emotional condition of children and adolescents in T1DM group and control group was evaluated by Depression Self-rating Scale for Children(DSRS)and the Screen for Child Anxiety Related Emotional Disorders(SCARED)respectively, and Symptom Checklist-90(SCL-90)was used for evaluating the mental health of all parents. Results:The average glycated hemoglobin A1c(HbA1c)of T1DM group was at the optimal level(7.406±1.294)%.The average HbA1c of CSII group was significantly lower than that of MDI group[(7.040±1.082)% vs(7.863±1.404)%, t=2.728, P=0.008].The depression rate of children and adolescents in T1DM group increased significantly than that of control group(31.9% vs 15.5%, χ2 =4.671, P=0.031).There were statistically significant differences among CSII group, MDI group and control group(20.0% vs 46.9% vs 15.5%, χ2 =11.591, P=0.003).The depression rate of children and adolescents in MDI group increased significantly than that of CSII group and control group(all P<0.05).CSII group showed similar results as compared with control group( P>0.05).Concerning the anxiety in children and adolescents, there was no significant difference between T1DM group and control group(19.4% vs 13.8%, χ2=0.730, P=0.393), and there were no significant differences among CSII group, MDI group and control group(15.0% vs 25.0% vs 13.8%, χ2=1.994, P=0.369).The emotional disorder prevalence of parents in T1DM group was remarkably higher than that of the control group(31.9% vs 5.2%, χ2=52.927, P<0.01).The factor scores of obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, paranoia and psychotic symptoms in T1DM group were higher than that of control group( P<0.05).There were statistically significant differences among CSII group, MDI group and control group(17.5% vs 50.0% vs 5.2%, χ2=26.126, P<0.01).The emotional disorder prevalence of parents in MDI group increased significantly than that of CSII group and control group(all P<0.05).But CSII group was same as that of control group( P>0.05). Conclusion:The children and adolescents with T1DM and their parents were high-risk population of emotional disorder.CSII can reduce not only the depression in the children and adolescents with T1DM, but also emotional disorder of their parents, thus CSII can improve the mental health in families suffering from T1DM.

Maternal-fetal outcomes of pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion or multiple daily injections during pregnancy - A Brazilian health care referral center cohort study

ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.

Use of flash glucose-sensing technology in patients with type 2 diabetes treated with liraglutide combined with CSII: a pilot study

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.

Change in HbA1c among filipino diabetic patients who shifted from multiple daily injection to continuous subcutaneous insulin infusion: A retrospective cohort study

Introduction@#Insulin delivered by multiple daily injection (MDI), for a time, has been considered to be the most physiologic among the different insulin regimen. Among patients on MDI, there is still a significant proportion who remains uncontrolled. Continuous subcutaneous insulin infusion (CSII) or insulin pump has been shown to benefit some patients who are still uncontrolled despite intensive insulin therapy with MDI. Currently, there is little information on the use of insulin pump in the Philippines. The researchers aim to determine the change in HbA1c and the proportion of patients with HbA1c of <8% after shifting from MDI to CSII. To correlate the change in HbA1c with age and baseline HbA1c. To compare the change in HbA1c between gender, type of diabetes and type of bolus regimen.@*Methods@#This is a retrospective cohort analytical study of 33 adult patients with type 1 or type 2 diabetes mellitus (DM), switched from MDI to insulin pump. Chart review was done to obtain data on age, gender, type of bolus, baseline HbA1c and HbA1c six to twelve months after switching insulin pump initiation. The change in HbA1c was correlated with baseline HbA1c and age. Mean change in HbA1c was also compared between gender, type of bolus and type of diabetes.@*Results@#Mean HbA1c prior to switching to insulin pump was 10±1.7. The HbA1c reduction was 1.86±1.6 (p<0.001, CI 1.38-2.34), resulting to a mean final A1c of 8.1±1.2 after CSII initiation. Seventeen out of 33 patients (52%) achieved an average HBA1c of <8%. A positive correlation was observed between HBA1c reduction and baseline HbA1c (r =0.738, p<0.001) but not with age (r = -0.002, p=0.99). There was no significant difference in the HbA1c reduction between male and female (p=0.353), Type 1 DM and Type 2 DM (p=0.133), and those that used fixed bolus vs bolus calculator (p=0.559). The reduction in A1c remains significant when analyzed as individual subgroups: 2.1±2.3 (p=0.001) in males; 1.6±1.0 (p<0.001) in females; 1.5±1.6 (p=0.001) in type 1; 2.3±1.6 (p<0.001) in type 2; 2.1±1.5 (p<0.001) in bolus calculator, and 1.7±1.8 (p<0.001) in fixed bolus group.@*Conclusion@#There is significant reduction in HbA1c among this cohort of Filipino diabetic patients after switching from MDI to CSII. While majority of patients had >1% reduction, achieving an ideal goal of <7% remains to be a challenge. Greater HbA1c reduction are seen in patients with higher baseline HbA1c. There is no significant difference in the reduction in HbA1c with respect to gender, type of diabetes and type of bolus used.

The basal rate characteristics of continuous subcutaneous insulin infusion in adult type 1 diabetes with islet failure / 中华内分泌代谢杂志

Objective To investigate the basal rate characteristics of continuous subcutaneous insulin infusion(CSII)in adult type 1 diabetes with islet failure. Methods Adult type 1 diabetic patients with islet failure, treated by CSII for more than 12 months but with poor glycemic control,were optimized for insulin dose through basal rate verification. The differences of blood glucose levels and insulin dosages were compared before and after CSII dose optimization. Results In 16 cases,HbA1Creduced from(7.6 ± 1.1)% by the time of enrollment to(7.0 ± 0.5)% after dose optimization(P<0.05),the minimal blood glucose level rose from(3.1 ± 1.1)mmol/L to(4.5 ± 0.7) mmol/L(P<0.01),and the maximal blood glucose level dropped from(18.6 ± 2.3)mmol/L to(12.0 ± 1.5)mmol/L (P<0.01). The total daily dosage of CSII reduced by about 17% (P<0.01)and the total basal insulin dosage reduced by about 43%(P<0.01)after dose optimization. The percentage of total basal insulin dosage to total daily dosage reduced from(43.6 ± 9.9)% by the time of enrollment to(29.4 ± 3.5)% after dose optimization(P<0.01). During 24 hours of the day,basal rate at 03: 00-08: 00 reached the peak level(1.3 times of the hourly average basal rate level)and basal rate at 20: 00-24: 00 fell to the valley level(60% of the hourly average basal rate level). Conclusions In adult type 1 diabetic patient with islet failure,the total basal insulin requirement of CSII is about 30% of the total daily dosage,with the peak level at 03: 00-08: 00 and the valley level at 20: 00-24: 00.

Evaluation of diabetic patients after three month use of continuous subcutaneous insulin infusion, dispensed by a protocolled form at outpatient reference clinic of Taguatinga Regional Hospital

Objective To evaluate the data of continuous subcutaneous insulin infusion protocol (CSII) for diabetics waived by the Health State Secretariat of Distrito Federal (HSSDF) and therapeutic responses three months after the transfer of multiple daily injections regimen for CSII. Subjects and methods Eighty patients (49 female) took part in this experimental study, mean age and disease duration were 27.9 years and 13 years, respectively; 96% patients had type 1 diabetes mellitus. Results The entire sample (ECO) and 3 subgroups (group 1 – A1c decrease, group 2 – A1c stable, and group 3 – A1c increase), stratified according to a ≥ 0.5% change in A1c, were analyzed. Group 1 involved 64% of the patients. The ECO showed a significant A1c decrease: MDI 8.1 ± 1.4% vs. CSII 7.3 ± 0.9%, p < 0.0001 (0.8% difference pro CSII therapy). Group 1 demonstrated an A1c decrease from 8.7% to 7.3% (1.4% difference). Group 2 mean A1c was 7.1%. Rate of hypoglycemia (< 50 mg/dL) decreased 61% in the ECO and 79% in Group 2. Conclusion This study reinforces the safety and efficacy of CSII with a robust A1c reduction and hypoglycemia. The pioneer care HSSDF ambulatory attests to be achievable the free dispensing by Unified Health System (UHS) following a protocol, and this approach results in less wastage to the patient and represents a rational policy of therapy with CSII for UHS. Arch Endocrinol Metab. 2015;59(1):23-8 .

Effect of short-term continuous subcutaneous insulin infusion treatment on beta-cell function, blood fat and C-reactive protein of newly diagnosed type 2 diabetes mellitus patients / 中国综合临床

Objective To investigate the effect on short-term continuous subcutaneous insulin infusion (CSII) treatment on beta-cell function,serum triglyceride(TG),C-reactive protein(CRP) and serum insulin like growth factor-1 (IGF-1) of newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods Thirty-two newly diagnosed T2DM patients with fasting plasma glucose(FPG) ＞ 11.1 mmol/L were treated with CSII for 2 weeks.FPG,2 h postprandial blood glucose (2hPG),fasting insulin (FINS),2 h postprandial insulin (PINS),fasting C peptide (FC-P),2 h postprandial C peptide (PC-P),glycosylated hemoglobin (HbA1 c),Homa-β,Homa-R,TG,CRP and IGF-1 were measured and compared before and after CSII.Results (1) Compared with that of before treatment,the levels of FPG,2hPG,HbA1c,PINS and PC-P in patients after treatment were dramatically improved(t =12.04,11.57,7.61,20.77,6.16; P ＜ 0.05),and Homa-β increased from (23.0 ±16.2) to (71.0±23.8)(t=9.46,P＜0.05),while Homa-IR significantly decreased from (6.8 ±2.1) to (3.9 ± 2.6) (t =4.81,P ＜ 0.05).(2) The levels of TG and CRP significantly decreased from (1.50 ± 0.32) mmol/L,(3.14±1.14) to (1.29±0.31) mmol/L,(1.95 ±0.52) mg/L(t =26.73,23.62;P ＜0.05).The levels of IGF-1 significantly increased from (341 ± 16) μg/L to (471 ± 17) μg/L (t =8.65,P ＜ 0.05).Conclusion The excellent glycemic control,improvement of lipid metabolism,anti-inflammatory and improvement of beta-cell function can be achieved with short-term CSII intensive therapy in newly diagnosed T2DM patients with severe hyperglycemia.

Correlation between body mass index and insulin dose in type 2 diabetic patients with continuous subcutaneous insulin infusion / 实用医学杂志

Objective To investigate the correlation between BMI and insulin dose in diabetic patients after short-term continuous subcutaneous insulin infusion (CSII). Methods Three hundred patients with type 2 diabetes mellitus (T2DM) were enrolled and randomized into the normal weight (BMI < 23 kg/m2) group, overweight (BMI 23 ~ 25 kg/m2) group and obesity (BMI≥25 kg/m2) group. The metabolic and anthropometric parameters of each group were compared and the related factors which may influence insulin dose were analyzed. Results The insulin dose per weight in the overweight group or in the obesity groups was significantly lower than that in the normal weight group. Weight and BMI were negatively correlated with the insulin dose per weigh. Conclusions Differences of glycemia level , β-cell function and insulin resistance exist in Chinese type 2 diabetes patients with different BMI. The stratification of BMI should be considered before estimating the insulin dose by body weight in CSII therapy.

Preliminary Study for Continuous Subcutaneous Insulin Infusion in Type 2 Diabetes Patients With Heart Diseases / 中国循环杂志

Objectives: To evaluate the effect and safety of 14-day continuous subcutaneous insulin infusion (CSII) in type 2 diabetes patients with heart diseases. Methods: A total of 22 consecutive type 2 diabetes patients (history ≤ 5 years) with heart diseases treated in our hospital from 2011-03 to 2013-08 were studied. There were 20 male, and the with the mean age of patieuts (48.15 ± 9.80) years, all patients without standard hypoglycemic treatment before admission. The patients received 14-day CSII for enhanced treatment and the blood glucose level, insulin function and insulin sensitivity were compared before and after the treatment. Results: After CSII treatment, the blood glucose level was obviously decreased, fasting blood glucose (FBG) and postprandial blood glucose at 30, 60 and 120 min were improved, all P Conclusion: CSII may quickly relieve glucotoxicity and improve insulin sensitivity in type 2 diabetes patients with heart diseases. Some patients may alleviate drug burden in clinical practice.

Effects of basal rate verification on CSⅡ dose adjustments in brittle diabetes / 中华内分泌代谢杂志

Basal rate verification is the process to find and verify the basal rate of continuous subcutaneous insulin infusion (CSⅡ) required for basal glucose metabolism.In the present study,five cases of brittle diabetes were treated by CSⅡ with Insulin Lispro.After doses were adjusted to reach steady blood glucose levels,basal rate verifying tests were carried out.The results showed that the overall level and stability of blood glucose were improved markedly after CSⅡ.Before and after the verification of the basal rate,there was no significant difference in CSⅡ total doses.Basal rates decreased from 50％ of total to 30％ (P＜0.05),and boluses increased to 70％ (P＜0.05).The basal rates during lunch and supper time were reduced by half (P＜0.05),the boluses of lunch and supper were increased 1.5 times (P＜0.05),and square waves were needed to control postprandial blood glucose.These results suggest that the CSⅡ could smoothly control blood glucose level in brittle diabetes without basal rate verification.However,the implementation of the verification could better determine the basal rates for basal glucose metabolism,and thus help to identify diet-related boluses.

Analysis of two intensive therapies in type 2 diabetes mellitus / 中华内分泌外科杂志

Objective To compare efficacy of two intensive therapies:continuous subcutaneous insulin infusion(CSⅡ) and multiple subcutaneous insulin infusion (MSⅡ) for treatment of type 2 diabetes mellitus.Methods 60 patients with type 2 diabetes mellitus were randomly divided into 2 groups. Patients in CSⅡ group were treated by insulin (Novolin R) through a infusion pump. Patients in MSⅡ group were treated by Novolin R before meals (3 times a day) and Novolin N at bedtime. Blood glucose was monitored the whole day before and after treatment. Time required for blood glucose to reach the standard level, insulin dosage and hypoglycemia incidence were compared between the 2 groups before and after treatment. Results Both of the 2 therapeutic methods effectively controlled blood glucose (P＜0.05). However, the 2 groups had significant difference in terms of the time required for blood glucose to reach the standard level ( 3.6 ± 1.2 d vs. 9.4 ± 3.2 d, P ＜ 0. 01 ), daily insulin consumption (35.2 ± 8.5 u vs. 43.2 ± 10. 1 u, P ＜0. 01 ) and hypoglycemia incidence (2. 1% vs.9.7%, P ＜0.01 ). Conclusions CSⅡ and MSⅡ are effective for treatment of type 2 diabetes mellitus. CSⅡ is superior to MSⅡ due to its advantages of quick response, safety, and less insulin consumption.

Short and long-term effects of CSII on diabetes after necrotizing pancreatitis / 中华内分泌代谢杂志

This paper presents a case of post-pancreatitis diabetes mellitus with seriously damaged islet function. The blood glucose level was successfully controlled by continuous subcutaneous insulin infusion ( CSII )therapy both in short and long terms.

Correlation between the dosage of premixed insulin analogue treatment and continuous subcutaneous insulin infusion treatment in type 2 diabetes / 中华内分泌代谢杂志

To observe the patients with type 2 diabetes who were injected premixed insulin analogues after short time continuous subcutaneous insulin infusion( CSII ) treatment.It was found that the patients needed premixed insulin analogue injection 2 times daily when the dosage of CSII was less than 45 U/d,and 3 times daily when the dosage was greater than 45 U/d.The relationship of dosages between premixed insulin analogue treatment ( Y ) and CSII treatment(X) was calculated by following equations:2 times daily premixed insulin analogue treatment:Y =13.093 +0.395X,3 times daily premixed insulin analogue treatment:Y =23.114+0.405X.

Comparison of the therapeutic effects between insulin glargine combined with nateglinide and continuous subcutaneous insulin infusion during intraoperative period in type 2 diabetic patients with fracture / 中华内分泌代谢杂志

To compare the effect of insulin glargine combined with nateglinide and continuous subcutaneous insulin infusion(CSII) during intraoperative period in type 2 diabetic patients with fracture. Both of the managements made blood glucose under control [fasting blood glucose(6.89±1.96)vs(6.75±2.33)mmol/L] in similar period [(3.6±1.6)vs(2.9±1.2) d,both P>0.05]. The mean blood glucose was lower in patients treated by CSII than that of the other group.

The effect and mechanism of transient continuous subcutaneous insulin infusion therapy on β cell function, insulin resistance and vascular endothelial injury in newly diagnosed type 2 diabetes / 中华内科杂志

Objectives To explore the effect of transient continuous subcutaneous insulin infusion (CSII) on β cell function, insulin resistance and vascular endothelial injury in newly diagnosed type 2 diabetic patients and its potential mechanism. Methods Ten patients with newly diagnosed type 2 diabetes mellitus (T2DM) accepted CSII for two weeks. Intravenous glucose tolerance test (IVGTT) and hyperinsulinemia euglycemia clamp test were performed before and after CSII. Serum soluble E-selectin (sE-selectin) was used to evaluate the injury of vascular endothelial cell, while serum high sensitivity C reactive protein (hsCRP) and soluble CD_(14) (sCD_(14)) were both used to assess inflammatory condition. Results (1) Compared with those before treatment, the blood glucose levels of IVGTT, the area under the curve of the blood glucose, glycosylated hemoglobin, TC and LDL-C in the patients were decreased after CSII (P < 0. 05 or 0. 01). (2) Compared with those before treatment, the insulin levels of IVGTT (except the fasting insulin), the area under the curve of insulin and acute insulin response were all increased after CSII(P < 0.05 or 0.01). (3) Compared with that before treatment, the glucose infusion ratio in the clamp test [(3.46±1.66)mg·kg~(-1)·min~(-1) increased to (7.14±2.37)mg·kg~(-1)·min~(-1)]and HOMA-β elevated, while HOMA-IR declined (P <0. 05 or 0. 01 in all). (4) Compared with those before treatment, the levels of serum sE-selectin, sCD_(14) and hsCRP were decreased (P < 0. 01, except for hsCRP) . Conclusion Transient intensive insulin therapy in patients with newly diagnosed T2DM is useful to restore 13 cell function, attenuate insulin resistance, repair vascular endothelial injury and improve the disorder of blood sugar and lipid. The mechanism may be related with the inhibition of inflammation in patients.

Application of continuous subcutaneous insulin infusion in desensitization for allergy to recombinant human insulin / 中华临床营养杂志

Objective To evaluate the values of continuous subcutaneous insulin/rapid insulin analoguc infusion in desensitization for allergy to recombinant human insulin. Methods Two patients allergic to recombinant human insulin received desensitization therapy by continuous subcutaneous insulin lispro infusion. The diluted insulin lispro solution was pumped with initial basal rate of O. O1 U/h, and the basal rate and insulin lispro concentration increased gradually until the insulin dosage for clinical treatment was reached. After that, continuous subcutaneous insulin lispro infusion was replaced by regimen of insulin lispro subcutaneous injection plus oral hypoglycemic agents. Results Local wheals were not observed in both two patients during continuous subcutaneous insulin lispro infusion or during bolus subcutaneous injection of insulin lispro after desensitization. Conclusion The desensitization therapy by continuous subcutaneous insulin/rapid insulin analogue infusion can be applied for allergy to recombinant human insulin.

Effects of short-term continuous subcutaneous insulin infusion on fasting plasma vaspin levels in patients with recent-onset type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma visceral adipose tissue-derived serine protease inhibitor ( vaspin ) levels in patients with recentonset type 2 diabetes mellitus, and to study the association between insulin sensitivity and vaspin levels.Methods Thirty patients with recent-onset type 2 diabetes mellitus were treated with CSII for 2 weeks.Euglycemic-hyperinsulinemic clamps (EHC) were performed to evaluate the insulin sensitivity in type 2 diabetes group. Plasma vaspin levels were measured by an ELISA kit. The association between plasma vaspin levels and metabolic parameters were analyzed. Results Fasting plasma vaspin levels were higher in type 2 diabetes than in impaired glucose regulation and normal glucose tolerance groups [( 1.83±0.55 vs 0. 43±0.21 and 0.56±0.26) ng/ml,P＜0.05]. With CSII,vaspin levels [( 1.19 ±0.57 vs 1.83 ±0.55 ) ng/ml, P＜0.05] and homeostasis model assessment for insulin resistance [HOMA-IR ,2.30 ( 1.09-7.2 ) vs 4.28 ( 1.7-6.47 ), P＜0.05] were significantly decreased,accompanied with an increase in glucose metabolic rate [(5. 10±0.51 vs 2.99±0.42 )mg·kg-1·min-1 ,P＜0.05] in type 2 diabetes group. Changes in circulating vaspin concentrations were correlated positively with changes in HOMA-IR. Conclusion In type 2 diabetic patients,elevated plasma vaspin levels are significantly decreased after CSII treatment. Vaspin may play a role in improving insulin sensitivity of diabetic humans.

Dynamic changes of glycemic excursions before and after treatment by continuous subcutaneous insulin infusion in new diagnosed patients with type 2 diabetes mellitus / 中国基层医药

Objective To observe the characteristics of glycemic excursion and to evaluate the therapeutic effects on blood glucose in new dignosed type 2 diabetes mellitus after being given continuous subcutaneous insulin infusion(CS Ⅱ).Methods Thirty-eight new dignosed type 2 diabetes mellitus patients were randomly divided into group CS Ⅱ(n=18) and group many-times subcutaneous insulin infusion(MS Ⅱ,n=20).The blood glucose lasted for three days were monitored by continuous glucose monitoring system(CGMS).Results The abnormal glucose metabolism in two groups were markedly released after two weeks treatment,the mean blood glycemic(MBG),mean amphtude of glycemic excursions(MAGE),means of daily differences(MODD) and the percentage of blood glucose beyond 7.8 mmol/L and 11.1 mmol/L after therapy were all significantly decreased compared with those of before therapy (P＜0.001);the average levels of blood glucose before and after diet were decreased obviously as well(P＜0.05,P＜0.01).All index in group CS Ⅱ were lower than that of group MS Ⅱ (P＜0.01,P＜0.001).Conclusion Continuous glucose monitoring system can assess the changes characteristics of blood glucose effectively,continuous subcutaneous insulin infusion was an effective means of controlling blood glucose.

The efficacy comparison between glargine and biphasic insulin aspart 30(BIAsp 30) after CSII in newly diagnosed type 2 diabetes mellitus / 中国糖尿病杂志

Objective To compare the efficacy and safety of glargine(Lantus) versus biphasic insulin aspart 30 (30% free and 70% protamine-bound, BIAsp 30) after continuous subcutaneous insulin infusion treatment (CSII) in newly diagnosed type 2 diabetes mellitus. Methods A 20 week open and random study was performed. All 60 patients with newly diagnosed T2DM were randomly divided into two groups. Group B patients was treated by glargine and group A received treatment with BIAsp 30 administered immediately before dinner and breakfast. Blood glucose at 7 time points, glycosylated hemoglobin A1c(HbA1c) and hypoglycemia were observed. Results The postprandial glucose(PPG) was significantly lower in group B than in group A (P<0.05), and the frequency of hypoglycaemic episodes was lower in group B than in group A (P<0.05). The fasting blood glucose(FBG) was not different between two groups (P>0.05). And there was no difference between two groups in HbA1c and other adverse events. Conclusions Glargine is surperior to BIAsp30, not only in controlling the PPG but also in reducing the incidence of hypoglycemia.

Cost-effectiveness analysis on continuous subcutaneous insulin infusion and multi-point daily insulin injections in the treatment program of type 2 diabetes / 中华流行病学杂志

Objective To observe the cost-effectiveness of using continuous subcutaneous insulin infusion (CS Ⅱ) and multi-point daily insulin injections (MDI) in controlling blood sugar in the newly hospitalized type 2 diabetes patients. Methods Retrospective analysis on 86 cases taking CS Ⅱ and 103 cases using MDI on a 'blood sugar control program' among the newly hospitalized patients with type 2 diabetes. The period for observation was 2 weeks, using cost-effectiveness analysis methods to evaluate the two treatment programs. Results After two weeks of treatment, the effectiveness in the control of blood sugar in CS Ⅱ group was similar to the MDI group, with no significant difference(P<0.05) and the adverse reactions were similar. Costs in the CS Ⅱ program (Yuan/person) was less than in the MDI program (1478.34 vs. 1620.46), with significant differences (P< 0.05). The cost-effectiveness ratios (C/E) were 15.07 in the CS Ⅱ group, and 16.34 in the MDI group, with no significant difference (P>0.05). In order to further reduce the cost of CS Ⅱ group as a reference, the incremental cost-effectiveness ratio (△C/ △E)ofthe MDI group was 129.20. Conclusion Costs-effective of the CS Ⅱ program was better than the MDI one in treating the newly hospitalized patients with type 2 diabetes, suggesting that CS Ⅱ program might be a better choice for hospitals to carry on an intensive insulin therapy program.