Effects Of Insulin Pump And Subcutaneous Insulin Infusion Therapy On Glycemic Control In Brittle Diabetics

Objective: A type of type I diabetes mellitus characterized by any kind of serious unstable conditions in glycemia requiring recurrent and/or long term hospitalization by altering the quality of life is defined as Brittle (unstable) diabetes who are admitted to hospital due to frequently recurring ketoacidosis, hypoglycemia and/or hyperglycemia. Brittle diabetes is the most difficult group of patients for the patients as well as diabetes team (physician, diabetes training nurse and dietician). Glycemic control can't be achieved easily despite intensive insulin therapy. Materials and Methods: The present study included 30 patients including 22 women and 8 men who were admitted to our clinic with brittle diabetes. Initially, doses of insulin pump were adjusted based on protocol for switching from multiple intensive insulin therapy to insulin pump. The patients were re-evaluated for glycemic control 3 months after discharge from the hospital. Results: Prior to insertion of insulin pump (IP), mean of fasting blood glucose was 237.66 +/- 69.51 mg/dl, mean fed blood glucose concentration 282.70 +/- 82.61 mg/dl, mean HbA1c level 8.74 +/- 02.29%,total insulin dose 45.13 +/- 10.75 U/day. Three months after initiation of continuous subcutaneous insulin infusion therapy, mean fasting blood glucose concentration was 93.63 +/- 23.25 mg/dl, mean post-prendial blood glucose concentration was 116.20 +/- 28.34 mg/dl, mean HbA1c was 6.34 +/- 0.81% (p<0.001), and total insulin dose was 38 +/- 16.45 U/day (p< 0.005). Conclusions: As our findings, the best option in the treatment of brittle diabetes which is unresponsive to multiple doses of insulin and makes a trouble for both the patient and the physician in achieving glycemic control is subcutaneous continuous insulin infusion despite its high cost.