Both Continuous Subcutaneous Insulin Infusion and a Multiple Daily Insulin Injection Regimen With Glargine as Basal Insulin Are Equally Better Than Traditional Multiple Daily Insulin Injection Treatment
- Giuseppe Lepore, MD,
- Alessandro R. Dodesini, MD,
- Italo Nosari, MD and
- Roberto Trevisan, MD, PHD
- From U.O. Diabetologia, Ospedali Riuniti Bergamo, Bergamo, Italy
Diabetes Control and Complications Trial results showed that strict metabolic control may substantially reduce the risk of long-term microvascular complications (1). Over the study period, which averaged 7 years, the mean HbA1c level in the intensive group treatment was 7.2%. Current guidelines of treatment for type 1 diabetes propose a goal of HbA1c <7% (2). Nevertheless, in usual clinical practice, an acceptable metabolic control is achieved in a too low proportion of patients, even under multiple daily insulin injections (MDIs) (3). A recent meta-analysis of randomized trials concluded that continuous subcutaneous insulin infusion (CSII) permits a small improvement in blood glucose control with respect to MDIs (4). Glargine insulin is a human insulin analog that might mimic the effects of CSII at single basal infusion rate. Preliminary studies indicate that glargine may reduce the incidence of hypoglycemia and fasting blood glucose compared with NPH (5).
Whether an MDI treatment with glargine as long-acting insulin may offer similar results to those obtained with CSII is still unknown (6). For this purpose, …
