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Outpatient treatment of juvenile-onset diabetes with a preprogrammed portable subcutaneous insulin infusion system
Insights
Portable insulin pumps significantly improve blood glucose control in patients with juvenile-onset diabetes. Continuous subcutaneous insulin infusion normalizes glucose levels and improves lipid profiles, enhancing quality of life outside the hospital.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Medical Devices
Background:
- Juvenile-onset, insulin-dependent diabetes requires intensive management.
- Conventional insulin therapy often struggles to achieve optimal glycemic control.
- Continuous subcutaneous insulin infusion (CSII) offers a potential alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of a portable insulin pump for continuous treatment of juvenile-onset diabetes.
- To assess the impact of CSII on blood glucose levels, glycosylated hemoglobin, and lipid profiles.
- To determine the feasibility of CSII in patients' usual environments.
Main Methods:
- Seven patients with juvenile-onset diabetes received continuous treatment with a portable insulin infusion pump for 12-32 weeks.
- Insulin was delivered subcutaneously in basal and pre-meal bolus doses.
- Blood glucose, glycosylated hemoglobin, and lipid levels were monitored.
Main Results:
- Mean blood glucose levels decreased from 237 mg/dl to 105 mg/dl within four weeks (p<0.01) and normalized (80-104 mg/dl) with continued use.
- Glycosylated hemoglobin levels fell from 16.0% to normal values (9.9%) within eight weeks (p<0.01).
- Elevated plasma cholesterol and triglyceride levels normalized; minor insulin dose adjustments were needed; no mechanical failures occurred.
Conclusions:
- Portable insulin pumps can achieve near-normalization of blood glucose levels in juvenile-onset diabetes patients.
- Continuous subcutaneous insulin infusion is safe and effective for outpatient management.
- CSII improves glycemic control and lipid profiles, allowing patients to maintain normal daily activities.
Abstract:
Seven patients with juvenile-onset, insulin-dependent diabetes (aged 13 to 32 years) were continuously treated for 12 to 32 weeks while out of the hospital in their usual environment with a portable, battery-powered infusion pump which delivers insulin subcutaneously in basal (between-meal) doses with pulse dose increments before meals. Mean blood glucose levels (237 +/- 28 mg/dl during conventional insulin therapy) fell to 105 +/- 5 mg/dl after four weeks of pump treatment (p less than 0.01) and were maintained at 80 to 104 mg/dl as pump treatment was continued beyond eight weeks. Glycosylated hemoglobin levels (16.0 +/- 1.5 per cent before pump therapy) also fell within two weeks (p less than 0.01) reaching normal values (9.9 +/- 0.3) after eight weeks of pump therapy. Mean plasma cholesterol and triglyceride levels were elevated during conventional therapy and fell to normal after pump treatment. After the first month of pump treatment, only minor adjustments in insulin dose (less than 5 per cent of total daily dose) were made. No episode of mechanical pump failure occurred during the 1,110 patient-days of treatment. Overinsulinization and underinsulinization due to human error were relatively rare (four and six episodes, respectively) and failed to result in symptoms of hypo- or hyperglycemia. All patients performed their usual home, work or school activities during pump treatment. We conclude that normalization or near normalization of blood glucose levels can be achieved with a portable subcutaneous insulin infusion system when continuously used to treat patients with juvenile-onset, insulin-dependent diabetes outside the hospital for three to eight months.