Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-44

2. Reduction in hypoglycemia • Rodriques et al. conducted a retrospective analysis to evaluate current UK guidelines (NICE) for use of CSII (93). The authors examined 40 patient cases with personal interviews and chart audits of individuals who had previously used an MDI plan. Their reasons for choosing pump therapy fell into two categories: o Severe Hypoglycemia (SH) needing assistance group: Met the approved indications for CSII, that is an A1C >7.5% and significant hypoglycemia (N=14). o Other group: Did not meet the SH criteria, but had other indications for starting CSII (N=25), such as personal choice, recurrent DKA, erratic lifestyle, poor control and pregnancy planning. • There were 15 individuals with classic contraindications in both groups. These contraindications included poor compliance with current therapy, not willing to calculate meal doses or test BG >4 times per day or previous psychiatric conditions, such as depression (N=12). The results were dramatic: o In the SH group, the A1C remained the same (8.1 vs. 8.2%), but the reduction in SH fell dramatically from 20.6 to 0.87 events per patient year. In terms of SH with convulsions, the rate decreased from 2.45 to 0.20 per patient year. o In the other indications group, the A1C was reduced 2.4% (10.9 to 8.5%) while also showing a decrease in SH events. Further, diabetic ketoacidosis (DKA) was reduced (2.33 (+5.74) vs. 0.35 (+ 1.36)/per patient year). • Thomas et al. also confirmed the ability of CSII to further lower the rate of hypoglycemia and improve awareness of lows (97). 3. Quality of Life • The EQUALITY study group studied quality of life (QOL) in 1,341 adults who used either CSII (481) or MDI (860, 90% using glargine) using the following measures (98): o Diabetes-Specific Quality of Life (DSQOLS): This evaluated the impact of CSII on social relations, leisure flexibility, fear of hypoglycemia, worries and daily hassles; improvement was shown only on the “diet restrictions” score (p=0.003). o Diabetes Treatment Satisfaction Questionnaire (DTSQ): With 36 as the maximum score, resulted in a higher score in CSII (30.1 vs. 26.2, p <0.0001). ▪ SF-36: No significant differences were detected. ● Other authors have investigated QOL with CSII, but the results have been inconclusive (78,83,85).