A comparison of insulin regimens in insulin-dependent diabetes mellitus

Glycemic control in 10 ambulatory patients with insulin-dependent diabetes mellitus was compared on three intensive treatment regimens: (1) twice-daily regular and lente insulin; (2) multiple preprandial injections of regular insulin accompanied by long-acting ultralente insulin; and (3) continuous subcutaneous insulin infusion with a portable infusion pump. All regimens included (1) careful attention to diet, exercise, and insulin; (2) patient self-monitoring of blood glucose; and (3) the use of algorithms for the attainment of improved control. Treatment periods were 2 mo in duration. All parameters of glycemic control evaluated (including inpatient mean plasma glucose, mean amplitude of glycemic excursions, M-value, urinary glucose excretion; glycosylated hemoglobin; and outpatient blood glucose values) showed marked improvement from baseline, yet no difference when the intensive regimens were compared with each other. All elements of the treatment system appeared to be important in achieving improved glycemic control.