Continuous subcutaneous insulin infusion treatment in insulin-dependent diabetic patients: a comparison with conventional optimized treatment in a long-term study

Abstract

The effects of continuous subcutaneous insulin infusion (CSII) by portable pump (Microjet MC2, Miles) and conventional optimized insulin therapy (OCT) on metabolic control were compared in a group of five insulin-dependent diabetic patients. A group of seven normal volunteers was examined as control. CSII treatment consisted of a basal insulin infusion and three boluses of 60 min, starting 30 min before each main meal. OCT was characterized by three daily s.c. insulin injections: regular insulin before breakfast and lunch, regular plus lente before dinner. Two protocols of study were performed. In the first one the metabolic (blood glucose, NEFA, 3-beta-OH-butyrate) and hormonal (free insulin, pancreatic glucagon, cortisol, growth hormone) profiles were examined in the hospital with the patients connected to a "blood glucose monitor," after 45 days of OCT and CSII treatment, respectively. In the course of CSII treatment, a better blood glucose profile was observed than during OCT (OCT: MBG = 162 +/- 18 mg/dl, M = 43 +/- 11, MAGE = 151 +/- 26 mg/dl. CSII: MBG = 133 +/- 8 mg/dl, M = 29 +/- 5, MAGE = 138 +/- 19 mg/dl: P less than 0.05), although the indices remained higher than in normal subjects (MBG = 85 +/- 3 mg/dl, M = 0.98 +/- 0.18, MAGE = 49 +/- 3.6 mg/dl). CSII treatment was also associated with an improvement of NEFA and 3-beta-OH-butyrate profiles. Plasma "free" insulin (IRI) ranged between 18.2 +/- 5.4 and 32 +/- 5.5 microU/ml during CSII. Plasma glucagon (IRG) concentration after overnight fast was 195 +/- 65 pg/ml and 220 +/- 55 pg/ml during OCT and CSII treatment, respectively, with minor changes throughout the day. (ABSTRACT TRUNCATED AT 250 WORDS)