Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI

Abstract

To evaluate whether continuous subcutaneous insulin infusion (CSII) may have any advantage over multiple daily injections (MDI) on glycemic control and treatment satisfaction in young patients with Type 1 diabetes in transition to an adult diabetes center. The study population consisted of 125 patients on MDI; 38 out of the 43 patients considered eligible for CSII completed the study and the 82 remaining on MDI served as control group. Glycemic control and treatment satisfaction [diabetes treatment satisfaction questionnaire (DTSQ)] were evaluated in all patients at baseline and after 12 weeks. At baseline, the two groups were well matched for demographic characteristics and glycemic control. DTSQ score was lower in CSII group (21.1 ± 8.8 vs. 25.1 ± 7.1, P = 0.011). After 12 weeks, a similar decrease in HbA1C was observed in both groups [difference -0.3 % (95 % CI-0.6 to 0.1, P = 0.847)]. Mean amplitude glucose excursions,blood glucose standard deviation, and overall hypoglycemia were significantly reduced in CSII group. DTSQ overall score increased in CSII and decreased in MDI (difference between groups = 9.9, 95 % CI 8.0-12.0, P<0.001), while perceived hyperglycemia and hypoglycemia decreased in CSII compared with MDI (difference:-2.5 and -2.0, respectively, P<0.001 for both). Among young Type 1 diabetic patients in transition from Pediatrics,CSII showed a similar efficacy in reducing HbA1c compared with MDI, with less hypoglycemia and glycemic excursions, and was better in improving overall treatment satisfaction and the rate of perceived hyperglycemia and hypoglycemia.