Beck RW et al. – This multicenter, randomized-controlled study assessed the glycemic outcome when switching from multiple daily injection (MDI) to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes using continuous glucose monitoring (CGM). Improvement in glycemic control measured by time was observed in the glucose range of 70 to 180 mg/dL. The occurrence of hypoglycemia was increased in the study and should be considered in clinical practice.

Methods

• A total of 75 adults with type 1 diabetes in the CGM group of the DIAMOND trial were randomly assigned to continue MDI or switch to CSII, with continuation of CGM, for 28 weeks.
• The primary outcome was CGM-measured time in the glucose concentration range of 70 to 180 mg/dL.

Results

• Overall, 97% of participants in the CGM plus CSII group (n = 37) and 92% in the CGM plus MDI group (n = 38) completed the study. No participants discontinued CSII.
• The CGN plus CSII group showed a greater reduction in CGM-measured mean glucose and hyperglycemia, but also an increase in CGM-measured hypoglycemia.
• Mean HbA1C change from baseline to 28 weeks was 0.3% in the CGM plus CSII group and 0.1% in the CGM plus MDI group
• Mean CGM use was almost similar (6.7 days vs 6.9 days per week) in the CGM plus CSII group and CGM plus MDI group.
• Mean time in the glucose concentration range of 70 to 180 mg/dL was 791 min/d in the CGM plus CSII group and 741 min/d in the CGM plus MDI group.
• Hypoglycemia occurred in 1 participant in the CGM plus MDI group, whereas the CGM plus CSII group had 1 case each of diabetes ketoacidosis and severe hyperglycemia.