Abstract
Compared to multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) has proven to reach target HbA1c level with less frequent hypoglycemia, be more cost-effective, and improve quality of life. However, data on the effectiveness of CSII therapy in the African American population remain limited. The primary objective of our study was to compare the effectiveness of CSII therapy in lowering HbA1c levels in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in a predominantly African American population. The secondary objective was to identify factors that affect the effectiveness of CSII. Participants were selected randomly from a list of patients currently receiving CSII at our institution’s diabetic clinic. Each patient’s consent was obtained over the phone or during a visit to the clinic. Primary data were collected with a questionnaire, whereas additional data, including HbA1c levels before and after starting CSII, were collected from medical records. A total of 57 participants were enrolled in the study. African Americans represented 79% of the participants; 43% of the participants were unemployed, and 56% had an annual income of less than 20,000 USD. Since commencing CSII therapy, all participants achieved a decrease in mean HbA1c level from 9.7% to 8.0% (P = 0.001), and that of African American participants decreased from 9.8% to 8.2%. Increase number of individuals at home was associated with less reduction in HbA1c levels after starting CSII therapy (P = 0.02). Overall, satisfaction with CSII therapy was high, and 63% of participants reported being very satisfied with the treatment. The mean BMI among participants while using MDI was 32.6 kg/m2 but significantly increased to 33.9 kg/m2 (P = 0.01) while using CSII. The increase in mean BMI after starting CSII therapy was significantly higher in participants with T2D than in ones with T1D (P = 0.001). While receiving MDI, female participants had a significantly higher mean BMI than their male counterparts (P = 0.02); however, that difference became nonsignificant after they began CSII therapy (P = 0.06). The level of physical activity after starting CSII therapy did not alter the risk of increased BMI. The results of our interim analysis indicate the significant effect of CSII in lowering HbA1c levels in all diabetic patients regardless of sex, race, BMI, type of diabetes, marital status, employment status, level of education, adherence to diabetic diet, physical activity, duration on CSII, and use of other antidiabetic medications. The significant increase in BMI once CSII therapy commenced may reflect the increase in insulin dose among patients who were not adherent to insulin while receiving MDI. Patients need to be aware of that side effect, and additional interventions for weight management may be considered for overweight and obese patients planning to start treatment with CSII.
Efficacy and safety of sitagliptin as add-on therapy on glycemic control and blood glucose fluctuation in Japanese type 2 diabetes subjects ongoing with multiple daily insulin injections therapy