RESALE OF REFURBISHED INSULIN PUMPS, IS IT POSSIBLE?

There is no doubt that CSII with Insulin pump Therapy has proved superior to MDI (multiple Dose Injection) therapy in Type1DM as well as Type2DM patients. Economics has been a very important issue while advocating the Pump to either patients, type 1 or type 2 Diabetes Mellitus patients. Out of 9 (Nine) patients using Insulin Pumps in our centre GANDHI CLINIC, PUNE, INDIA, there are 5(FIVE) Type 2 patients and 4(FOUR) Type 1DM patients. Two Pumps are deposited at my Clinic due to the sad demise of the Type2DM patients. The relatives of these patients do wish to sell these pumps with some depreciation price i.e. at lower price than the new one. One patient (type2DM) has stopped using the Insulin pump due to the adverse advice from another healthcare provider. This person with Diabetes also wants to sell the pump at some discounted price. As per my survey in the Metro city of Pune (INDIA) approximately 700 insulin pumps are sold, out of these at least 5-7% of total pumps are not being used anymore. The unused pumps are at least 50 in number in this city of PUNE. Total number of pumps used in INDIA is 70000-72000 pumps approx. The total unused pumps by the patients in INDIA could be about 3000 to 5000 pumps approximately. This revenue loss in this resource constrained country could be in millions of Dollars. This scenario may be same in many developing countries wherein the healthcare budgets are limited. In INDIA, Insulin Pump Therapy is not yet covered by Insurance policy of all the patients. Since the pumps are usually purchased by pocket expenses or with Loan or selling some assets like land or Gold, the relatives of the patients are not wrong in expecting some financial recovery after losing the most important thing ie the PERSON. This is also to be considered if patient does not want to continue the use of pump due to any reason. We do see refurbished cars sold and there are eligible and deserving candidates available who cannot purchase a new model of the Car. I am sure INDIA is an important market of Diabetes Technology related Products like Insulin Pump and CGMs. This article is aimed at KOLs in Diabetology and Economists in the world for a basic policy change in favour of the patient care and economics.

Lesiones cutáneas asociadas al uso de bombas de insulina y sistemas de monitoreo: un problema desafiante / Insulin pumps and glucose monitors related cutaneous lesions: a challenging problem

Los cuidados actuales de la diabetes incluyen altos niveles de tecnología y los pacientes utilizan diferentes dispositivos que pueden ayudar en su control metabólico, pero pueden impactar negativamente en su piel. Sensores de glucosa como el Freestyle, Dexcom, el Enlite de Medtronic y los sistemas de infusión continua de insulina contienen diferentes productos químicos que están en contacto directo con la piel del paciente y pueden causar una dermatitis irritativa o de contacto alérgica. Las lesiones incluyen eczema, prurito, heridas, cicatrices y cambios en la pigmentación de la piel. Los productos químicos involucrados que pueden ocasionarlas son el isobornil acrilato, N, N- dimetilacrilamida, etil cianoacrilato y colophonium, forzando a los pacientes a cambiar los sitios de infusión, el set de infusión o el sensor mismo más pronto de lo esperado, para reducir el nivel de daño en la piel. Existe gran número de productos que permiten proteger la piel y reducir el contacto de la piel con la cánula de la bomba o el sensor. Para reducir o prevenir el daño existen productos como cremas o spray y parches de hidrocoloide que actúan como barrera y existen técnicas para aplicar y retirar cuidadosamente los parches y adhesivos de los dispositivos. Una vez que las lesiones se han producido, el tratamiento incluye pomadas y a veces corticoides tópicos y/o antibióticos. Para prevenir o reducir el daño de la piel asociado al sensor y uso de la bomba de insulina, la industria que los produce debería incluir la información en relación a los productos químicos incluidos en cada dispositivo.

Diabetes care nowadays includes a high level of technology and patients use different devices which can help them in their glycemic control, but can have a negative impact on their skin. Glucose sensors such as Freestyle, Dexcom, Medtronic Enlite and also continuous subcutaneous insulin infusion systems contain different chemical products which are in direct contact with the patient's skin and can cause irritative or allergic contact dermatitis. Lesions include eczema, pruritus, wounds, scars and changes in skin pigmentation. The chemical products which can induce them are isobornyl acrylate, N, N- dimethylacrylamide, ethyl cyanoacrylate and colophonium, forcing patients to change the infusion site, set or the sensor itself, earlier than expected, in order to reduce the level of skin damage. There are a number of products which can protect the skin and reduce it's contact with the pump cannula or the sensor. To reduce or prevent damage, we have products such as barrier cream or spray films and hydrocolloid blister plasters and actions such as careful application and removal of device's patches and adhesives. Once lesions are established, treatment includes ointments and sometimes topical steroids and/ or antibiotics. In order to prevent or reduce skin damage related to sensor and insulin pump use, the manufacturers should include the information related to the chemicals included in each device.

Xingnaojing injection and insulin pump combined with decompression in treatment of severe craniocerebral injury with diabetes mellitus / 中华内分泌外科杂志

Objective:To investigate the clinical efficacy and adverse reactions of Xingnaojing injection combined with insulin pump in treatment of severe craniocerebral injury (STBI) complicated with diabetes mellitus.Methods:Data of 102 patients with STBI combined with diabetes mellitus admitted from Jan. 2017 to Jan. 2020 in the Surgical Intensive Care Unit of Yantaishan Hospital were prospectively analyzed. Their average age was (48.27±4.20) years. They were randomly divided into group A (34 cases, treated with simple decompression) , group B (34 cases, treated with insulin pump combined decompression) and group C (34 cases, treated with Xingnaojing injection and insulin pump combined decompression) . Fasting blood glucose (FPG) , 2 h postprandial blood glucose level (2 h PG) , interleukin 2 (IL-2) , interleukin 6 (IL-6) , serum high sensitivity C-reactive protein (hs CRP) and glasgow coma scale (GCS) was different, and the incidence of adverse reactions was recorded. SPSS 23.0 statistical software was used for data processing. The measurement data were mean±standard deviation, and t test was used; the counting data were expressed in (%) and χ 2 inspection was used. Results:After treatment, there was no significant difference in 2 h PG, FPG, IL-2, IL-6, hs CRP or GCS scores between group A and group B ( P>0.05) . After treatment, the levels of 2 h PG and FPG were (8.89±1.74) mmol/L and (7.53±1.59) mmol/L in group C, (7.30±1.62) mmol/L and (6.25±1.50) mmol/L in group A, (7.32±1.64) mmol/L and (6.29±1.56) mmol/L in group B. The levels in group C were higher than those in group A and group B ( P<0.05) . The levels of IL-2, IL-6 and hs CRP in group C were (792.74±86.58) ng/L, (8.82±1.73) ng/L and (7.95±1.44) mg/L respectively. The three indexes were (880.85±90.29) ng/L, (13.85±2.20) ng/L and (14.02±2.28) mg/L respectively in group A; (875.37±89.72) ng/L, (13.34±2.18) ng/L, and (13.37±2.26) mg/L respectively in group B. Group C was lower than group A and group B ( P<0.05) . The GCS score of group C was 11.45±2.23 (points) , and that of group A and group B were 8.09±1.52 (points) and 8.73±1.56 (points) respectively. Group C was higher than that of group A and group B ( P<0.05) . Compared with group A and group B, the incidence of adverse reactions in group C was lower, and the difference was statistically significant ( P<0.05) . Conclusion:Xingnaojing injection and insulin pump combined with decompression are of great significance in reducing adverse reactions and improving the safety of clinical treatment.

Therapeutic Observation of Continuous Subcutaneous Insulin Infusion at Acupoint for Type 2 Diabetes / 上海针灸杂志

Objective To observe the difference between continuous subcutaneous insulin infusion (CSII) at acupoint and CSII at non-acupoint in treating type 2 diabetes, for providing a novel option in selecting the insulin injection site. Method Sixty-six subjects with type 2 diabetes were randomized into a treatment group of 32 cases and a control group of 34 cases. The treatment group was intervened by CSII at acupoint, while the control group was intervened by CSII at non-acupoint. The body mass index (BMI), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (P2hPG), bedtime blood sugar, glycated hemoglobin (HbA1c), consumption of insulin, and the score of diabetes symptom grading and quantification of the two groups were compared. Result The blood sugar level, insulin consumption, HbA1c level and symptom score declined significantly after treatment in both groups (P<0.05);the BMI and initial dosage of insulin in the treatment group dropped significantly after treatment in the treatment group (P<0.05); after treatment, the BMI, FPG level, initial dosage of insulin and symptom score in the treatment group were markedly lower than those in the control group (P<0.05); there were no significant differences between the treatment group and the control group in the P2 hBG level, bedtime glucose sugar level, HbA1c level, pre-prandial insulin dose and total effective rate (P>0.05). Conclusion CSII at acupoint and at non-acupoint both can effectively improve the disease condition of type 2 diabetes. The treatment group is superior to the control group in controlling BMI and FPG, reducing the initial level of insulin, and improving the symptoms, and the treatment group presents a higher total effective rate with the increase of treatment duration compared with the control group. It is indicated that insulin infusion at abdominal acupoint has a certain advantage in the treatment of type 2 diabetes.

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.

Comparison of the Effects of 2 Kinds of Administration Routes of Insulin on Related Indexes of Advanced Age Patients with Gestational Diabetes Mellitus / 中国药房

OBJECTIVE:To compare the effects of repeated subcutaneous insulin administration vs. insulin pump continuous subcutaneous administration on related indexes of advanced age patients with gestational diabetes mellitus(GDM). METHODS:Inretrospective study,120 advanced age patients with GDM were randomly divided into group A(60 cases)and group B(60 cases). Group A was given Insulin aspart injection with initial dose of 0.5 U/(kg·d)subcutaneously before meal,adjusted according to fast-ing blood glucose(FPG)and postprandial 2 h blood glucose(2 hPG),and then given Isophane protamine biosynthetic human insu-lin injection with initial dose of 0.5 U/(kg·d)subcutaneously at bedtime,adjusted according to FPG and 2 hPG. Group B was giv-en Insulin aspart injection with initial dose of 0.5 U/(kg·d)added into insulin pump using 40% of total daily insulin as basic pump,increasing to 60% of total daily insulin if blood glucose control was poor,adjusted according to FPG and 2 hPG. Treatment course of 2 groups lasted for 4 weeks. The time of blood glucose reaching target,the amount of insulin were observed in 2 groups, and the levels of FPG,2 hPG,HbA1c,Hcy and Cys-C before and after treatment,the occurrence of patients and neonates compli-cations. RESULTS:The time of blood glucose reaching standard in group B was significantly shorter than group A;the amount of insulin,the incidence of hypoglycemia,premature birth,excessive amniotic fluid and gestational hypertension in group B were sig-nificantly lower than group A,with statistical significance(P0.05). After treatment,the levels of FPG,2 hPG,HbA1c,Hcy and Cys-C in 2 groups were significantly lower than before treatment,and the group B was significantly lower than the group A, with statistical significance(P<0.05). CONCLUSIONS:The insulin pump continuous subcutaneous administration is significantly better than repeated subcutaneous insulin administration in respects of controlling glucose level,reducing the amount of insulin,the levels of Cys-C and Hcy,maternal and neonatal complications.

Effect of Short-term Insulin Intensive Therapy on the Blood Glucose and Lipid Levels of Patients with Type 2 Diabetes / 现代生物医学进展

Objective:To investigate the effect of short term and intensive insulin pump on the blood lipid and glucose levels of patients with type 2 diabetes.Methods:76 patients with type 2 diabetes were selected and divided into two groups according to different administration.The control group (38 cases) was given routine insulin aspart treatment.The observation group (38 cases) was treated by insulin pump.The blood and lipid indexes and ADL score before treatment,at 1 week and 2 weeks after treatment were compared between two groups.Results:After treatment,the levels of FPG,HbAlc,TC,TG and LDL-C were lower than those before treatment and the level of HDL-C was increased in both groups.The levels ofFPG,HbAlc,TC,TG,LDL-C of observation group were lower than those of the control group,and the level of HDL-C of observation group was higher than that of control group (P＜0.05).At 1 week,2 weeks after treatment,the ADL scores of both groups were significantly improved,and the ADL score of observation group was higher than that of the control group (P＜0.05).Conclusion:Short term intensive insulin pump could significantly improve the blood glucose and lipid metabolism disorders in patients with type 2 diabetes,and improve the ability of daily life.

Effect of short-term insulin pump therapy on left ventricular systolic function in type 2 diabetes mellitus patients evaluated by three-dimensional speckle tracking imaging / 中华超声影像学杂志

Objective To assess the improvements of left ventricular systolic function by three‐dimensional speckle tracking imaging ( 3D‐STI) in type 2 diabetes mellitus ( T2DM ) patients after short‐term insulin pump intensive therapy . Methods Thirty‐five T2DM patients complicated with microangiopathy and thirty‐two healthy volunteers were studied ,underwent the dynamic image of the four‐chamber view ,three‐dimensional images of left ventricle were obtained for all the individuals . The left ventricular global longitudinal strain ( LVGLS) ,left ventricular global circumferential strain ( LVGCS) ,left ventricular ejection fraction (LVEF) ,peak basal and apical rotation (LV‐ProtB ,LV‐ProtA) ,peak LV twist ( LV‐tw ) were calculated using TomTec software .After insulin pump intensive therapy for two weeks ,all the indexes were reexamined in T2DM patients . Results Compared with control group ,the LVGLS , LVGCS ,LV‐tw and LV‐ProtA were significantly decreased in diabetes mellitus group before and after treatment ( P < 0 .01 or P < 0 .05) . Compared with diabetes mellitus patients before treatment ,the LVGLS ,LVGCS had significant higher level after treatment( P <0 .05) . The LVGLS ,LVGCS ,LV‐tw and LV‐ProtA were significantly correlated with LVEF in type 2 diabetes mellitus patients and normal controls . Conclusions Insulin pump intensive treatment could improve left ventricular systolic function in type 2 diabetes patients complicated with microangiopathy . 3D‐STI can be sensitive to accurately assess the therapeutic effect and has the important clinical value .

Evaluation of the effect of different insulin administration methods on glucose control of gestational diabetes mellitus / 中国基层医药

Objective To study the effect of different insulin administration methods on glucose control of gestational diabetes mellitus ( GDM) .Methods Sixty-four cases with GDM were randomly divided into observation group and control group.The observation group received continuous subcutaneous insulin infusion insulin pump therapy, the control group received multiple subcutaneous insulin therapy.Then,the glucose control effect,SAS and SDS score were compared between two groups.Results After 4 weeks,the FBG,HbA1c,2h PG of observation group were significantly lower than the control group[(5.89 ±0.66)mmol/L vs (7.13 ±0.74)mmol/L,(7.14 ±0.82)% vs (8.92 ±0.95)%,(8.87 ±0.92)mmol/L vs (10.13 ±1.32)mmol/L](t=7.074,4.430,8.024,all P<0.05). The glucose fluctuations,insulin amount,hypoglycemia incidence of the observation group were significantly lower than the control group,blood sugar standard time was shorter than the control group[(5.64 ±0.65)mmol/L vs (8.44 ± 0.92)mmol/L,(0.52 ±0.06)U· kg-1· d-1 vs (0.73 ±0.09)U· kg-1· d-1,6.25% vs 28.13%,(4.76 ± 0.55)d vs (7.41 ±0.94)d,t/χ2 =14.061,10.983,5.379,13.764,all P<0.05)];SAS score,SDS score of the observation group were significantly lower than the control group[(34.95 ±4.2) points vs (40.23 ±3.98) points, (35.12 ±3.95)points vs (38.36 ±3.88)points,t=5.162,3.310,all P<0.05)].Conclusion Continuous subcu-taneous insulin infusion insulin pump therapy is helpful to control glucose levels,reduce blood sugar fluctuations and mitigate negative sentiment during treatment,it is an ideal insulin administration method for the treatment of GDM.

Clinical efficacy of short term intensive insulin pump therapy and biosynthetic human insulin therapy and its effect on maternal and neonatal outcomes in gestational diabetes mellitus / 中国生化药物杂志

Objective To investigate the clinical effect of insulin on gestational diabetes mellitus(GDM).Methods GDM patients were randomly divided into group A and group B,group B were treated with short term intensive insulin pump therapy,and group A were treated with insulin pump in short term combined with biosynthetic human insulin therapy.Results The body mass index and diabetes family history rates pre-pregnancy in group B were significantly higher than group A(P<0.05).Logistic analysis showed that family history of BMI pre-pregnancy and diabetes family history were independent risk factors for GDM drug treatment(P<0.05).Compared with the group B,the improvement of blood glucose levels and the incidence of complications in patients with group A were better than the former(P<0.05).Conclusion Rational application of insulin can improve the efficacy of clinical treatment of GDM, reduce the incidence of complications, with high safety.

Comparison of the effect of ultrashort and short -acting insulin after subcutaneous insulin infusion pump un-der glucose monitoring in treatment of diabetes / 中国基层医药

Objective To investigate the efficacy of ultrashort and short-acting insulin after subcutaneous insulin infusion pump under glucose monitoring in treatment of diabetes.Methods 110 cases with type 2 diabetes were selected,they were randomly divided into two groups with a random number table:the study group and the control group,55 cases in each group.The study group was treated with short -acting insulin after subcutaneous injection of insulin pump,the control group was treated with short -acting subcutaneous insulin infusion by insulin pump therapy, glucose monitoring system was used to monitor glucose during treatment of the two groups.The clinical efficacy after a month of treatment was observed.Results Before treatment,fasting blood glucose(FPG),postprandial 2 h blood glucose(2h PG),bedtime blood glucose of the two groups had no statistically significant differences.After treatment, FPG and 2hPG,bedtime blood glucose in the study group were (6.01 ±1.06)mmol/L,(7.90 ±0.50)mmol/L, (7.13 ±0.95)mmol/L respectively,which of the control group were (5.98 ±1.04)mmol/L,(7.91 ±0.48)mmol/L, (7.14 ±0.94)mmol/L,which were significantly lower than before treatment (t =9.843,23.669,13.569,9.683, 22.881,13.710,P 0.05).The blood glucose time and insulin dosage in the study group were (5.59 ±1.30)d,(39.98 ±11.01)u/d,which of the control group were (6.98 ±1.40)d,(51.89 ±11.97)u/d,and there were significant differences between the two groups(t =1.825,5.431,P <0.05).The mean blood glucose,blood glucose standard deviation,time percentage of blood glucose≥10 mmol/L,time percentage of blood glucose≤3.9 mmol/L in the study group were (5.95 ±0.61 )mmol/L, (1.28 ±0.25)mmol/L,(14.16 ±2.13)%,(6.35 ±1.45)%,which in the control group were (6.59 ±0.94)mmol/L, (1.54 ±0.29)mmol/L,(15.15 ±2.14)%,(7.96 ±1.42)% respectively,and the differences were statistically significant between the two groups(t =4.236,503.6,2.432,5.883,P <0.05).Conclusion Glucose monitoring system in monitoring blood glucose is accurate and reliable,ultra -short -acting insulin after subcutaneous insulin pump infusion in treatment of diabetes is better than short -acting insulin.

Bombas de insulina (BI) / Insulin pumps (IP)

En la década pasada, el conocimiento sobre la historia natural y fisiopatogenia de la diabetes tipo 1 tuvo un importante crecimiento, particularmente en relación con predicción, heterogeneidad, patología pancreática y su epidemiología. Las mejoras tecnológicas específicamente en el desarrollo de bombas de insulina y sensores continuos de glucosa ayudan a los pacientes con diabetes tipo 1 en el desafío de la administración de insulina a largo plazo. A pesar de grandes inversiones sobre distintos aspectos de la enfermedad (financiación de proyectos, organizativos, educacionales, etc.) no existe hasta el momento la prevención ni la cura para la diabetes tipo 1, y sumado a esto la calidad sobre el manejo de la enfermedad es muy heterogéneo. Como el control glucémico mejora con un tratamiento intensificado (múltiples inyecciones de insulina), el número y frecuencia de eventos hipoglucémicos tienden a incrementarse. La hipoglucemia es generadora de cuadros de estrés, ansiedad y deterioro de la calidad de vida en los pacientes con diabetes. Una de las razones por las cuales existe gran dificultad de alcanzar los objetivos glucémicos en pacientes con diabetes tipo 1 es la variabilidad en la absorción de la insulina inyectada en forma subcutánea, la que conlleva mayor e impredecible variabilidad en la concentración glucémica y todo esto en general se relaciona con valores elevados de hemoglobina glicosilada e hipoglucemia. La terapia con bomba de insulina se inició hace más de 30 años con el objetivo de mejorar el control en pacientes con diabetes tipo 1. El objetivo de esta revisión es actualizar las herramientas tecnológicas en el tratamiento de la diabetes. (AU)

Over the past decade, knowledge of the pathogenesis and natural history of type 1 diabetes has grown substantially, particularly with regard to disease prediction and heterogeneity, pancreatic pathology, and epidemiology. Technological improvements in insulin pumps and continuous glucose monitors help patients with type 1 diabetes manage the challenge of lifelong insulin administration. Agents that show promise for averting debilitating disease-associated complications have also been identified. However, despite broad organisational, intellectual, and fiscal investments, no means for preventing or curing type 1 diabetes exists, and , globally, the quality of diabetes management remains uneven. As glycemic control improves with intensified insulin regimens, the frequency of hypoglycemia tends to increase. Hypoglycemia is the cause of considerable stress and anxiety, impaired well-being, and poor quality of life in patients with type diabetes. One reason for continued poor glycemic control in patients with type 1 diabetes is the erratic absorption and action of subcutaneously injected insulin, which lead to unpredictable swings in blood glucose concentrations, and those swings, in themselves, are associated with elevated glycated hemoglobin levels and hypoglycemia. Insulinpump therapy, or continuous subcutaneous insulin infusion, was introduced more than 30 years ago as a procedure for improving glycemic control in patients with type 1 diabetes. The primary goal is to perform an up date about the new technological tools in diabetes treatment. (AU)

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 .

Intensive Insulin Therapy in Type 1 Diabetes / 임상당뇨병

The Epidemiology of Diabetes Interventions and Complications study, a prospective observational follow-up of the Diabetes Control and Complications Trial cohort, reported persistent benefits for micro- and macro-vascular complication in type 1 diabetes mellitus with intensive insulin therapy. It is the standard of care for most patients with type 1 diabetes. There are two modalities: continuous subcutaneous insulin infusion (CSII), so called insulin pump, and multiple dose of insulin. Both shows similar effects in frequency of severe hypoglycemia and progression of microvascular disease, but CSII provides slightly better in glycemic control. An important aspect of intensive insulin therapy is educating patients about basal insulin, and carbohydrate/insulin ratio, sensitivity index, the coordination of meals, activity, stress, and hormonal changes with frequent monitoring of blood glucose levels during pregnancy. It is important to identify and resolve emotional and attitudinal barriers of the patient and family for improving glycemic control during intensive diabetes management.

The clinical efficiency of insulin pump therapy combined with Novolin 30R in patients with diabetes mellitus complicated with pulmonary infection and analysis of detection indexes / 国际检验医学杂志

Objective To investigate the clinical efficiency of Isophane Protamine Biosynthetic Human Insulin Injection (pre‐mixed 30R)(Novolin 30R) combined with insulin pump therapy in patients with diabetes mellitus complicated with pulmonary in‐fection ,and to analyze the detection indexes .Methods From Jan .2010 to Feb .2013 ,90 cases of patients with diabetes mellitus com‐plicated with pulmonary infection were selected and divided into the observation group and control group .The control group re‐ceived Novolin 30R treatment and conventional treatment ,the observation group were given insulin pump therapy based on the treatment of control group .The clinical efficiency and detection indexes were compared and analyzed .Results The cure rate and to‐tal effective rate were 51 .11% and 82 .22% respectively in the control group ,and were 84 .44% and 100 .00% in the observation group respectively .There were significant differences of both cure rate and total effective rate between the two groups (P<0 .05) . There were statistically significant differences of hospitalization time ,the time for reaching target of glucose ,insulin dose ,recovery time of body temperature ,hospital costs ,incidence rate of complications ,serum levels of sodium ,potassium and urea nitrogen ,os‐molality and PH value between the two groups(P<0 .05) .Conclusion The combination of Novolin 30R and insulin pump therapy could provide satisfactory clinical efficiency in patients with diabetes mellitus complicated with pulmonary infection .

Comparation of clinical value between subcutaneous insulin pump and multiple subcutaneous insulin intensive treatment on type 2 diabetes combined with stroke / 国际检验医学杂志

Objective To explore the clinical value of the insulin pump(CSⅡ) and multiple subcutaneous insulin intensive treat-ment(MDI) for patients with type 2 diabetes and stroke .Methods A total of 80 patients with type 2 diabetes and stroke in Weifang Community Health Service Center from April 2011 to May 2014 were selected as subjects and divided into experimental group and control group according to random number table method ,with 40 cases in each group .Patients in the experimental group were trea-ted with CSⅡ ,patients in the control group were treated with MDI .Glucose level ,therapeutic time ,the number of low blood sugar , insulin dosage ,National Institute of Health Stroke Scale(NIHSS) score ,insulin secretion index(IS) ,insulin resistance index(IR) , hospital costs were compared before and after treatment in the two groups .Results The glucose levels ,therapeutic time ,the num-ber of low blood sugar ,insulin dosage ,NIHSS score ,IS ,IR in the two groups before and after breakfast ,before and after lunch ,be-fore dinner ,after dinner 2 hours before treatment had no significant differences(P>0 .05) ,the glucose levels ,therapeutic time ,the number of low blood sugar ,insulin dosage ,NIHSS score ,IS ,IR after treatment in both groups were significantly decreased at these time points ,but those indicators in the experimental group decreased more significantly ,and had significant differences with those of the control group(P<0 .05) .The cost of hospitalization of patients in the experimental group was significant lower than that in the control group(P<0 .05) .Conclusion CSⅡ treatment for type 2 diabetes and stroke patients ,not only control glucose level well ,re-duce the number of low blood glucose and insulin dosage ,significantly improved IS and IR ,reduce hospital costs ,and also could sig-nificantly improve the neurological disorders of consciousness ,which is an ideal treatment method compared with MDI .

A survey of prevalence of depression in diabetes mellitus patients with long-term treatment of insulin pump / 西安交通大学学报(医学版)

Objective To investigate the prevalence of depression and its influencing factors in type 2 diabetes mellitus (T2DM)patients with long-term treatment of insulin pumps.Methods A total of 120 T2DM patients receiving long-term insulin pump treatment were enrolled,and 180 T2DM patients who received intensive insulin injection without pump in the same period were enrolled as controls.We assessed the depression in the two groups using Zung’s self rating scale.Results The depression scores of 32 patients with insulin pump were more than 0.50,and the depression prevalence of these patients was 26.67%,which was significantly lower than 48.89% in the control group (P < 0.05 ). The prevalence of moderate or severe depression was 3.33% and 1.67%, respectively,in the insulin pump group,which were considerably lower than the prevalence of 1 5.56% and 9.44%in the control group (P <0.05).Duration of DM and the number of complications might be independent risk factors of depression in DM patients with insulin pump.Conclusion Long-term use of insulin pump may effectively improve depressive state in T2DM patients through its optimal effect on maintaining blood glucose levels.

THE NURSING OF INSULIN PUMP REINFORCED GESTATIONAL DIABETES TREATMENT / 现代医院

Objective To study the nursing features and effects of using insulin pump in gestational diabetes , and to grope for pregnant women during pregnancy care and education mode , how to make the gestational diabetes pregnant women safely through pregnancy to ensure that maternal and child health.Methods A retrospective analysis were done on 47 cases of gestational diabetes pregnant which treated by insulin pump from January 2004 to January 2009, reinforced therapy of using insulin pump and comprehensive care measures including mental nursing, diet therapy, appropriate physical training, skill nursing, healthy education and so on were taken.Results The blood glucose of all patients were well controlled, there were no complication of hypoglycemia reaction, hypoglycemia reaction, diabetic hyperosmolar coma, diabetic ketoacidosis and fetal distress in uterus.Conclusion It is considerable significance that perfect pregnancy care, active and effective nursing inter-vention for reducing infant and maternal complications and ensuring maternal and child health .

Comparison of two different insulin intensive therapy plan on treating type-2 diabetes mellitus patients / 中国综合临床

Objective To compare the effect of insulin pump continuous subcutaneous insulin (CSII) and multiple subcutaneous insulin (short-acting insulin before meals + glargine,MSII) for the short duration of type 2 diabetes mellitus (T2DM) patients.Methods Fifty-two newly diagnosed T2DM patients were randomly divided into CSII(n =29) and MSII(n =23) group.Patients in CSII group were given insulin pump continuous subcutaneous plus metformin.And patients in MSII group were given insulin by multiple subcutaneous insulin injection plus metformin.The treating periods was 2 weeks and followed up one month.Results The periods from point of insulin injection to blood glucose back to normal level in CSII group was (4.70 ±2.01) d,shorter than that in MSII group(6.90 ± 1.50) d,and the difference was significant(t =2.056,P ＜0.05).The levels of C peptide in two hours postprandial before and after treatment in CSII group were (4.24 ± 0.25) ng/L,(6.29 ± 0.56) ng/L,and (3.20 ±0.11) ng/L and (7.33 ±0.41) ng/L respectively in MSII group.The levels of C peptide in two hours postprandial after treatment were higher than that of before treatment in two groups (t =2.018,2.436 respectively,P ＜0.05),but there were no significant differences between two groups(t =0.985,P ＞ 0.05).Nineteen cases (65.5％) in CSII group were off insulin treatment in one month,and 9 cases (39.1％) in MSII group.There were significant differences in two groups(x2 =5.11,P ＜0.05).Conclusion The two treatment plans can make the improvement in terms of glucose control.However,CSII plan showed more effective than MSII.

Application of double C program in the perioperative period of coronary artery bypass / 中国综合临床

Objective To observe the clinical efficacy of the double C program consisting of glucose monitoring systems (CGMS) and insulin pump (CSⅡ) in perioperative period of patients undergoing coronary artery bypass patients with type2 diabetes mellitus (T2DM).Methods Divided participants who underwent coronary artery bypass surgery with T2DM into double C treatment group (double C group,n =20) and multiple subcutaneous insulin group (MSⅡ group,n =30).Before and after surgery,blood sugar control in blood glucose time,blood sugar fluctuations,the amount of insulin,the incidence of low blood sugar,incision infection,and total hospitalization days were observed.Results Comparing the double C treatment group with the MSⅡ group,blood sugar fluctuations ((5.76 ± 1.42) mmol/L vs.(7.91 ± 1.68) mmol/L,P ＜ 0.05),the amount of insulin ((38.82 ± 16.97) U/d vs.(49.00 ± 15.32) U/d,P =0.032),the blood sugar compliance time ((3.52 ± 1.13) d vs.(6.00 ± 4.27) d,P =0.002),hypoglycemia (4 cases vs.1 case,P =0.025),the incision infection rates in both the cases(P =0.948),the total admission days((23.68 ± 13.67) d vs.(30.12 ± 2.94) d,P =0.084).Conclusion The double C program is comprehensively effective.for the perioperative glycemic control of patients with T2DM undergoing coronary artery bypass.