Objective: To evaluate continuous subcutaneous insulin infusion (CSII) in type 1 diabetes using the analysis of epidemiological variables, treatment indications, metabolic results, acute and chronic complications and causes for therapy suspension.
Methods: A retrospective descriptive study of patients with type 1 diabetes treated with CSII therapy in our institution.
Results: A total of 49 type 1 diabetic patients who had been treated with CSII were evaluated (age: 31.9±8.3 years; female: 67.3%, time of evolution of diabetes: 16.5±8.1 years). Before starting CSII, retinopathy was present in 46.9%, microalbuminuria in 8.2%, macroalbuminuria in 4.1%, polineuropathy in 2.0% and vasculopathy in 2.0% of the subjects. The indications for CSII treatment were: brittle diabetes (38.7%), poor metabolic control (32.6%), pregnancy (16.3%), pregnancy planning (8.2%) and hypoglycemias (4.1%). Patients received CSII therapy during 22.2±12.1 months. Hemoglobin A1c before starting CSII therapy was 8.3±1.2% and improved significantly during treatment: 7.1±0.9% after 3 months, 7.3±1.2% after 9 months, 7.4±0.9% after 12 months, 7.6±1.4% after 18 months and 7.5±1.4% after 24 months of CSII therapy (P<0.001). CSII also reduced the frequency and severity of hypoglycemias. During CSII therapy 3 patients had diabetic ketoacidosis (6.1%), 4 developed retinopathy (8.2%), 3 microalbuminuria (6.1%) and in 5 patients the previous retinopathy progressed (10.2%). Seven patients discontinued CSII: 3 for patient wish, 3 due to the end of pregnancy and one because treatment failure.
Conclusions: The most frequent indications for CSII therapy in patients with type 1 diabetes in our institution are brittle diabetes and poor metabolic control, and the most frequent causes for therapy suspension are the patient wish and the end of pregnancy. CSII is a safe and effective treatment to optimize metabolic control in type 1 diabetic patients.
03 - 07 May 2008
European Society of Endocrinology