Glargine basal-bolus insulin regimen versus insulin pump therapy: comparison of glycemic control

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BACKGROUND: Study results have varied when blood sugar control for subjects using a glargine basal-bolus insulin regimens (GBBIR) have been compared with those using continuous subcutaneous insulin infusion (CSII). Of 12 studies comparing GBBIR with CSII, six found improved glycemic control with CSII and six found no significant difference. These studies were often limited by small numbers of subjects and other study design parameters. METHODS: We reviewed hemoglobin (Hb) A1c data for youths with type 1 diabetes (n=43) changing from conventional split mix insulin regimens (CSMIR) to GBBIR and subsequently to CSII at 3, 6 and 12 months after each transition. All subjects had a diabetes duration of at least 1 year before initiating GBBIR. RESULTS: HbAlc levels at 3 months, 6 months and 1 year were not significantly different for GBBIR and CSII regimens. HbAlc increased significantly during GBBIR (p=0.036) and marginally during CSII (p=0.058) when 3-month and 1-year values were compared. CONCLUSIONS: We found no significant difference in glycemic control, as reflected by HbAlc, in youths with type 1 diabetes treated with GBBIR and CSII for up to 1 year. Blood sugar control waned by 12 months in both the GBBIR (p=0.036) and CSII (p=0.058) groups, which suggests that "burn out" qually affects those on each regimen. Additional investigation of glycemic variability and quality of life for those on GBBIR and CSII would be clinically relevant.

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