Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections
Modeling predicted benefits in relationship to baseline A1c
- Ravi Retnakaran, MD12,
- J. Hans DeVries, MD3,
- Helene Hanaire-Broutin, MD4,
- Robert J. Heine, MD, PHD5,
- Vincent Melki, MD4 and
- Bernard Zinman, MD12
- 1Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- 2Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- 3Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
- 4Service de Diabetologie, Hospital de Rangueil, CHU de Toulouse, Toulouse, France
- 5Department of Endocrinology, Diabetes Center, VU University Medical Center, Amsterdam, the Netherlands
- Address correspondence to Dr. Bernard Zinman, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Lebovic Building, 5th Floor, Room L5-024, 600 University Ave., Toronto, ON, Canada, M5G 1X5. E-mail: zinman{at}mshri.on.ca
With either continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injection (MDII) therapy, the optimal meal insulin is a rapid-acting analog (lispro or aspart). To date, the efficacy of CSII versus MDII therapy has been evaluated in a limited number of randomized controlled trials in which rapid-acting analogs were used for both regimens. In this context, we recently conducted a pooled analysis (1) using raw trial data from three such studies undertaken in adults with type 1 diabetes (2–4). This analysis suggested that CSII is associated with better glycemic control, particularly in those patients with poor initial control. Indeed, the relative benefit of CSII over …
