Endocrine Abstracts

Aims: There are few data comparing oxidative stress markers in CSII versus MDI/G We compared after randomization CSII (Continuous subcutaneous insulin infusion) vs MDI/G therapy (multiple doses of insulin with glargine) in DM1 people previously optimized at MDI/G being the primary objective assessment of metabolic control and oxidative stress.

Assess oxidative stress and metabolic control in patients with type 1 diabetes (T1D) after randomization in CSII (continuous subcutaneous insulin infusion) therapy vs MDI/G (multiple daily injections with glargine) previously optimized MDI/G.

Materials and methods: Thirty eight patients (29.8±8.5 years) with type 1 diabetes T1D of long duration (13±7 years), HbA1c 8.4±1.2%, treated with MDI/NPH, were intensified for 6 months at MDI/G and then randomized to MDI/G vs CSII, both with Lispro for rapid analogue, and reviewed monthly during six months. At the end of each phase, metabolic control variables and total antioxidant capacity (TAC) (EIA, Cayman Chemical) were evaluated. Glycemic control was assessed by HbA1c, data derived from the MCG for 72 h CGMS® (Medtronic), rate of mild and severe hypoglycemia, and ketoacidosis.

Results: At 6 months of treatment with MDI/G (n=38), with a larger number of self-test (P=0.001), total insulin daily dose (P=0.04), HbA1c (P=0.02), glycemic variability (P=0.04), number of severe hypoglycemia episodes (P=0.01), and TAC (2.3±1.2 vs 1.3±0.5 mM; P=0.001) decreased while time in normoglycaemia (P<0.05) and BMI (P=0.01) increased.

After 6 months of randomization, TAC and HbA1c improved significantly only in the CSII group reaching at the end of the study better levels than in the MDI/G group (TAC: MDI/G 1.48±0.84 vs CSII1.94±0.58; P=0.03; HbA1c: MDI/G 7.6±0.9 vs ISCI 7±0.6%;P=0.006). No correlations between TAC and variables studied were appreciated.

Conclusions: This randomized study shows that in patients with DM1 previously optimised, CSII therapy may provide additional benefits in HbA1c and oxidative stress markers versus MDI/G. Studies with larger sample size and other oxidation markers must confirm these findings.