Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo - Online first: 2018-07-13
Intensive Insulin therapy with Continuous Subcutaneous Insulin Perfusion Device
Introduction: Intensive insulin therapy is widely used in type 1 diabetics, with the goal of mimicking the physiological secretion pattern of insulin, aiming to achieve good metabolic control. It can be done through Multiple Insulin Daily Injections (MIDI) or a Continuous Subcutaneous Insulin Perfusion Device (CSIPD). Several studies have shown a statistically significant difference in mean HbA1c between groups submitted to CSIPD and MIDI, suggesting that CSIPD possibly contributing to an improvement in glycemic control. Objective: To compare the strategies of intensive insulin therapy through CSIPD and MIDI in relation to glycemic control, microalbuminuria, lipid profile, BMI and frequency of adverse events. Material and Methods: Observational and Retrospective study including 59 type 1 diabetic patients followed at the Endocrinology department of the Centro Hospitalar São João on intensive insulin therapy through CSIPD for more than 6 years, having previously used the MIDI strategy for a period of more than 6 months. Data were collected from the clinical process concerning both the period in which they performed MIDI and the placement of CSIPD (HbA1c value, total cholesterol, HDL cholesterol, triglycerides, microalbuminuria, weight, height, insulin:carbohydrate ratio (I:CH), insulin sensivity factor (ISF), number of emergency department episodes / admission in the ward and frequency of severe hypoglycaemia). Results: 59 patients with a mean age of 41±10 years were diagnosed with type 1 diabetes at 16±10 years of age and had an average disease duration of 17±9 years at the time of CSIPD placement. HbA1c values were significantly lower in the 3 CSIPD periods compared to the MIDI period. Lipid profile, ISF and I:CH ratio were not statistically significant different in any of the periods. The median values of microalbuminuria of the MIDI period were identical to the period of use of CSIPD. Regarding BMI, a statistically significant increase was found 6 years after CSIPD placement. The frequency of adverse events associated with CSIPD therapy was reduced. Conclusions: The change from MIDI to CSIPD strategy allowed better glycemic control to be achieved over the first 6 years, with no change in lipid profile or high frequency of adverse events.