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1 2016

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Treatment of patients with type 1 diabetes – Insulin pumps or multiple injections?

Krzymien J., Rachuta M., Kozlowska I., Ladyzynski P., Foltynski P.

Biocybernetics and Biomedical Engineering

2016

Vol. 36, no. 1

1--8

In theory, the continuous subcutaneous insulin infusion (CSII) has a few advantages over the multiple daily insulin injections (MDI) that should lead to improved glycemic control and lower risk of hypoglycemia. In practice, both treatment regimens allow for adequate control of glycemia. The objective of this review is to discuss the most important factors contributing to this situation. We made a comprehensive evidence-based review of the factors affecting effectiveness of CSII and MDI, with a special attention to algorithms for insulin dose adjustments and the automatic bolus calculators. Regardless of the treatment regimen that is used a few different interdependent factors influence the final result of the intensive insulin therapy. These factors comprise: patients' education, attitude, emotional stability and compliance, and careful analysis of the treatment results by a physician establishing the appropriate rate of basal insulin infusion or the basal dose of insulin and adjusting insulin doses to: the meals, the planned physical activity and the actual and target glucose levels. Our study implies that good glycemic control in patients with type 1 diabetes requires not only a thorough patient education and complying with medical recommendations, but also an individual determination of therapy goals and ways of achieving them. That is why, regardless of the treatment method that is applied, it is the choice of appropriate algorithms and adjusting them to the patient's way of life what allow for achieving pre-specified therapeutic goals. Technical means such as automatic bolus calculators might supplement but they cannot replace patients education and compliance.