Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes

To assess the effect of continuous subcutaneous insulin infusion (CSII) on glycemic control, hypoglycemia, and daily insulin requirements in five older patients with long-standing type 1 diabetes previously treated with multiple-dose insulin injections (MDII).

We undertook a retrospective analysis of five older patients (three women and two men) with type 1 diabetes and a mean age of 66.4 years (range, 57 to 76). The mean duration of disease was 33 years (range, 18 to 49), and all patients had suboptimal glycemic control (glycosylated hemoglobin or HbA(1c) >8.0%), presence of microvascular complications, and unacceptably frequent hypoglycemia during MDII therapy. A diabetes care team monitored their clinical course after their treatment was changed to a CSII regimen. Data pertaining to HbA(1c), severe hypoglycemia, and insulin dose before and after conversion to CSII were compared with use of paired t tests.

After initiation of CSII therapy, the mean HbA(1c) value decreased from 9.16% to 7.6% (P<0.0025), the rate of severe hypoglycemia decreased from 3.2 episodes to 0.4 episode per year (P<0.02), and the mean total daily insulin dose was reduced from 44.9 IU to 32.4 IU (P<0.05) during a mean duration of 12.6 months of CSII therapy.

Insulin pump therapy can prove highly beneficial in older patients with type 1 diabetes by improving glycemic control, reducing hypoglycemic episodes and insulin dosage, and possibly increasing treatment satisfaction. These changes can potentially prevent morbidity and prove to be cost-effective. For implementation of pump conversion to be safe and successful, careful patient selection, proper education, and ongoing support through a comprehensive diabetes education and management program are imperative. Future reports of experience with CSII in elderly patients should help to elucidate its promising advantages in this patient population and provide guidelines for use.