Prospective study of comparing efficacy of Continuous Subcutaneous Insulin Infusion of Insulin Aspart versus Multiple Daily Injection of Insulin Aspart/Insulin Glargine in patients of Type 1 Diabetic mellitus

Background: Intensive insulin therapy is an aggressive treatment approach to control the blood sugar levels of diabetic patient. Multiple daily injection (MDI) therapy and continuous subcutaneous insulin infusion (CSII) are current methods of it. Intensive insulin therapy requires close monitoring of blood sugar levels along with multiple doses of insulin. Aims and Objective: To compare the CSII of insulin aspart with MDI of insulin aspart / insulin glargine in type 1 diabetic (T1DM) patients previously treated with CSII. Materials and Methods:  Eighty T1DM patients were randomly selected. Initially for first week all subjects were kept on insulin aspart by CSII. After one week 40 subjects shifted to MDI therapy i.e. insulin aspart before meal and insulin glargine at bedtime and 40 subjects remained with CSII. After 5 weeks of first treatment subjects were shifted to the alternate treatment for 5 weeks. During the last week of each treatment blood glucose was monitored for 48 to 72 h continuously. Results: Mean serum fructosamine levels were significantly lower after CSII therapy than after MDI therapy (343 ± 47 vs. 355 ± 50 µmol/l, respectively; P = 0.0001). Continuous glucose monitoring profiles over a 24-h time period showed that glucose exposure was 24 and 40% lower for CSII than MDI. Hypoglycemic episodes were reported as 92% in CSII and 94% in MDI. Conclusion: Subject on CSII therapy with insulin aspart showed lower glycemic exposure without enhanced risk of hypoglycemia, as compared to the subjects on MDI with insulin aspart and insulin glargine.