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Insulin Pumps vs. Multiple Daily Injections (MDI): Which is Better?

Can insulin pumps reduce glycemic variability in type 1 diabetes?…

A new cross-sectional observational cohort study looked at continuous subcutaneous insulin infusion (CSII), aka insulin pump, versus multiple daily injections (MDI) to determine which insulin delivery system resulted in less blood glucose variability in type 1 pediatric diabetes patients. Large variations in blood glucose have been implicated in causing cardiovascular complications which can lead to a number of comorbidities and mortality in diabetics.

This recent study was performed in 48 pediatric type 1 diabetes patients, 22 of whom used an insulin pump while the others used MDI. The patients were followed for 3 days using continuous blood glucose monitoring; blood glucose variability was also assessed in 2 consecutive 24 hour periods by a surrogate marker, F2-isoprostanes and/or urinary prostaglandin F2 excretion. Results showed that standard deviation of mean glucose concentration (p<0.05) and insulin requirements, HDL-cholesterol, the mean of glycemic excursions (p<0.01) were statistically lower in the insulin pump group.

While the study did not specifically look at the impact of insulin pump use vs. MDI on cardiovascular complications, one could assume that limiting glucose variations would have a positive impact on the cardiovascular system. The study was small and the MDI groups were even smaller. Each MDI group had somewhere between 4 – 9 patients who were assigned certain insulins whether that be normal, fast acting, basal and/or a combo of thereof. Further research and longitudinal studies would be of benefit to better assess association of CSII therapy versus MDI therapy and their impact on cardiovascular, co-morbidity, and mortality outcomes.

Practice Pearls:

  • Large variations in plasma glucose have been implicated in causing cardiovascular complications.
  • Patients with type 1 diabetes are significantly more likely to develop cardiovascular disease versus their peers.
  • Using continuous subcutaneous insulin infusion seems to be associated with reduced variations in blood glucose levels versus using multiple daily injections in type 1 diabetes.

Schreiver, C. et al. Glycemic Variability in Pediatric Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII) or Multiple Daily Injections (MDI). Clin Endocrinol. 2013;79(5):641-647