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Twenty insulin-dependent diabetic patients participated in a 1-yr prospective randomized cross-over study comparing multiple subcutaneous injections (MSI) and continuous subcutaneous insulin infusion (CSII) complemented by home blood glucose monitoring. While 4 patients dropped out early, 16 patients completed the study. Patients had severe insulin deficiency documented by absent C-peptide response to glucagon stimulation. A marked improvement in control was observed when mean blood glucose and glycosylated hemoglobin A1 were compared with conventional therapy. No significant differences in the degree of metabolic control achieved, as measured by mean fasting, preprandial, and postprandial capillary blood glucose (CBG), M values, glycosylated hemoglobin A1 concentration, cholesterol and triglyceride levels were seen between MSI and CSII in the sixteen patients who completed the study. However, individual comparisons showed that fasting CBG and M-values were lower under CSII than MSI in seven patients (P less than 0.05). In contrast, two patients exhibited lower M values under MSI than under CSII (P less than 0.01), while for the remaining seven patients the results were similar. After completion of the study, two patients went back to conventional insulin therapy, seven patients remained on the pump, and seven patients chose to stay on MSI. In conclusion, on a long-term basis, the two methods can produce comparable levels of blood glucose and glycosylated hemoglobin in ambulatory insulin-dependent diabetics.
Schiffrin et al. (Mon,) studied this question.