Continuous subcutaneous insulin infusion in the treatment of juvenile-onset diabetes

Control of glycemia by means of continuous subcutaneous insulin infusion (CSII) was examined in two groups of diabetic patients. In the first group of five totally insulin-dependent diabetics, the glycemic profile was compared in hospital during optimized conventional insulin therapy and CSII. A second group of five recently diagnosed diabetic patients was treated for periods up to 70 days with CSII. Two insulin infusion systems were used: (1) a commercially available infusion pump and (2) a specially developed device, permitting a more flexible infusion rate and including an audible warning of malfunction. In the first group the mean plasma glucose levels decreased significantly under CSII (202 +/- 18 mg/dl vs 151 +/- 18 mg/dl; p less than 0.05; mean +/- SEM) although the M value and the MAGE index were similar during CSII and the optimized conventional therapy. In the second group of subjects, improved diabetic control, as assessed by the mean blood glucose level (135 +/- 18 mg/dl), and M value and the MAGE index, was rapidly achieved by CSII in all patients. Insulin requirements fell to zero in two of the three patients who maintained CSII at home for 60 and 70 days. It is concluded that CSII permits blood glucose control at least as good as optimized conventional treatment in totally insulin-dependent diabetics in hospital as well as in newly diagnosed diabetics.