A Randomized, Prospective Trial Comparing the Efficacy of Continuous Subcutaneous Insulin Infusion with Multiple Daily Injections Using Insulin Glargine

Doyle EA, Weinzimer SA, Steffen AT, Ahern JA, Vincent M, Tamborlane WV. Diabetes Care. 2004;27:1554-1558.

Although both continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) with insulin analogs are widely used in the treatment of type 1 diabetes, this is the first randomized, prospective trial to directly compare these two methods of insulin administration in youth with type 1 diabetes. The aim of the study was to compare the efficacy of CSII and MDI using insulin analogs in lowering A1C levels among children and adolescents with type 1 diabetes. Thirty-two subjects with type 1 diabetes (age 8 to 21 years) were randomized to treatment with once-daily glargine by injection (with premeal/snack insulin aspart) or CSII (with insulin aspart) for 16 weeks. Treatment goals included A1C<7% and blood glucose levels of 70 mg/dL to 120 mg/dL (premeals) and 90 mg/dL to 150 mg/dL (at bedtime). After 16 weeks of treatment, A1C levels decreased by 0.9%, from 8.1% to 7.2%, in the CSII group (P<.02 vs baseline; P<.05 vs injection group). No significant change in A1C was observed in the injection group, which was 8.2% at baseline and 8.1% at 16 weeks. Total daily insulin dose did not change in the injection group but decreased by 0.5 units/kg with CSII (from 1.4 units/kg at baseline to 0.9 units/kg at 16 weeks, P<.01). Self-monitored fasting blood glucose levels were found to be similar in both groups, and lunch, dinner, and bedtime levels were significantly lower in those subjects using CSII (P<.01). Overall, CSII was found to be more effective than MDI with insulin analogs in lowering A1C levels.