05. tbl. 97. árg. 2011

Treatment of type 1 diabetes with continuous subcutaneous insulin infusion (CSII) in adults in Iceland

Meðferð sykursýki tegund 1 með insúlíndælu hjá fullorðnum á Ísland

Objective:The goal of the study was to evaluate the effect and safety of CSII treatment in individuals 18 years and older with type 1 diabetes mellitus in Iceland.

Methods: The research is retrospective. We gathered information from patient data of 40 individuals, age 19-57 years who had been treated with CSII in Iceland for 6 months or longer during the period January 2004 until December
2007.  We looked at the effect of the treatment on treatment complications, HbA1c, body mass index (BMI) and insulin requirements compared with multiple daily injections (MDI).

Results:HbA1c was lower on CSII but the difference was not significant. Mean initial HbA1c was 7.23 (95% confidence limits 6.29-8.18) for men and 6.93 (95% confidence limits 6.57-7.28) for women. The change in BMI was not significant. Mean initial BMI for men was 25.5 (95% confidence limits 23.6-27.3) and 25.9 (95% confidence limits 23.8-27.9) for women. Insulin requirements were significantly lower at the end of the study for both men and women. Insulin requirements decreased by mean 11.3 units for men (P=0.04) and 12.8 units for women (P=0.0009). There where six  episodes of ketoacidosis, four of skin infections and two hypoglycemias that needed doctors attention while using CSII treatment.

Conclusion: The experience of CSII treatment in Iceland is good. These results confirm that this treatment is safe and as effective as other treatment forms. Even tough the difference in HbA1c was not significant the result showed that those who had the highest HbA1c at the beginning of CSII treatment did get the best result with the pump and the insulin dosage was lower with CSII than with MDI.

Fig. 1.

Insulin pump with an infusion set. Treatment with insulin pump involves continuous subcutaneous insulin infusion with short acting insulin. The pump weights approximately 100gr. Within the pump is a reservoir filled with insulin that lasts for about 3 days and then needs to be changed by the patient himself. The infusion set is connected to a needle that is placed under the skin with a probe similar to a venflow, most often on the abdomen.

Fig 2.

Regular meal bolus is given all at ones similar to using a insulinpen.

Fig. 3.

Dual wave bolus. A part of the insulinbolus is given immediately and the rest is distributet over a longer period of time, from 30minutes up to 8 hours. This method is convenient for a meal consisting of high fat and high carbohydrate content such as pizza.

Fig. 4.

Square wave bolus is give over a longer period of time form 30minutes to 8 hours.

Fig 5.

HbA1c remained unchanged for the most part for each patient. Each individual is numbered and person number 33 had the greatest reduction in HbA1c but he also started out with the highest number.

Fig. 6.

Body mass index for 29 individuals (men and women) was stable. Each individual is numbered and it is shown how BMI develops during the treament period.

 Fig. 7.

Insulin requirements for men and women. Insulin daily dose (u) versus time in months from the start of CSII usage, for each individual  who had  insulin doses documented at least twice. Subject specific regression lines show the trend for each person.


Table I.

Indications and contraindication for the use of CSII.

Key words:Diabetes, Continuous subcutaneous insulin infusion, HbA1c, Insulin dose, hypoglycemia.

Correspondence: Arna Guðmundsdóttir, arnagu@landspitali.is

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