A feasibility study of the use of continuous subcutaneous insulin infusion in a diabetic clinic: patients' choice of treatment

Abstract

Insulin-treated diabetic patients attending a busy diabetic clinic were approached to determine their interest in using continuous subcutaneous insulin infusion (CSII) via a portable pump. Three hundred and eighty-two patients were offered the choice of CSII, intensified conventional therapy (ICT) or continuation of less intensified treatment. One hundred and sixteen patients (30.4%) chose CSII, 169 (44.2%) chose ICT, 97 (25.4%) chose the less intensive regimen. Those choosing CSII represented a broad cross section of the clinic population, though older patients with a longer duration of diabetes tended to continue with less intensified therapy. There were no differences between groups in the level of blood glucose control or the prevalence of complications at the outset of the study. Of 104 patients not previously using CSII, 86 have so far commenced the therapy. Twenty-seven (32.6%) of these discontinued within one year, 23 doing so in the first three months of treatment. Metabolic control, assessed by glycosylated haemoglobin, was significantly improved in the CSII group after three months and in the other treatment groups by six months. Glycosylated haemoglobin levels achieved with CSII were significantly lower at three and six months when compared with the other treatments.