Avaliação dos Efeitos da Transição de Múltiplas Injeções Diárias de Insulina para Infusão Subcutânea Contínua de Insulina no Tratamento Intensivo da Diabetes Mellitus Tipo 1

Abstract

the physiological pancreatic althought is limited evidence its superiority to MDI. study to assess the effects of the transition from MDI to CSII in the intensive treatment of type 1 DM. Material and Methods: A retrospective longitudinal study was performed in MDI patients that transited to CSII between 2006 and 2014. Data were collected regarding to weight, HbA1c, plasma glucose, lipid profile, creatinine, weekly frequency of episodes of hypoglycemia and hyperglycemia and presence of microvascular complications. The effects of the transition to CSII were also com - pared according to the following subgroups: pre-CSII HbA1c (≤ 7.0% vs >7.0%); age (≤ 35 years vs > 35 years); gender (male versus female); BMI (≤25 vs >25 kg/m2); duration of illness (≤ 15 years vs > 15 years); total daily dose (TDD) of insulin (≤ 45 and > 45 units of insulin); ISF (≤ 40 and > 40) and microvascular complications (presence versus absence). Results: The sample included 85 patients, mean age 38 ± 11 years, 50 (58.8%) female, with duration of the disease 21 ± 9 years. There was a significant reduction in the frequency of hypo and hypergly - cemia events after transition to CSII (3.0 ± 5.0 vs 2 ± 2.2 per week, p = 0.001 and 5.5 ± 6.1 vs 2.5 ± 2.6 per week, p = 0.05, respectively). We also observed a greater glycemic benefit in the subgroups of patients with poorer metabolic control (HbA1c > 7%) compared to those with HbA1c ≤7% (Δ HbA1c =-0.55% vs 0.20%, respectively, p < 0.05), for the first 6 months after CSII, being addition - ally reported a significant increase in HDL-C levels (2.81 ± 10.34 mg/dL, p = 0.039). Conclusion: In this study, CSII therapy was shown to be more effective compared to MDI in pa - tients with poorer metabolic control, being also noted a significant reduction of weekly frequency of hypo and hyperglycemia events. Notwithstanding the encouraging results linked with CSII, in the future, longer longitudinal studies will be mandatory in order to assess the real relative effectiveness of CSII in the treatment of type 1 DM.