Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Basal or bolus dose, which is the key factor in CSII?

Objective: To observe the value of HbA1c level evaluating the total daily basal insulin dose by continuous subcuta- neous insulin infusion (CSII) in 268 patients with type 2 diabetes mellitus. Methods: 5-point capillary blood glucose was moni- tored in pre- and post-CSII and the insulin dose which could stabilize blood glucose was defined as the total daily dose of insulin, including basal and bolus total dose. Correlation between HbA1c level and total daily dose of insulin in patients with type 2 dia- betes mellitus was analyzed. Correlation between HbA1c level and 5-point capillary blood glucose was also analyzed. Results: Obvious correlation was observed between HbA1c level and the basal total daily dose of insulin if HbA1c was more than 9.3% (r=0.635, P<0.05). The average of 5-point capillary blood glucose was best correlated with HbA1c and fasting blood glucose next best. Conclusion: HbA1c level can forecast basal total daily dose of insulin in CSII.

A 2-way cross-over,open-labeled trial to compare efficacy and safety of insulin Aspart and Novolin R delivered with CSII in 21 Chinese diabetic patients

Background Subcutaneous absorption is accelerated by the monomeric conformation of insulin Aspart, which provides good glycemic control with a lower risk of hypoglycemia and less body weight increase. In the present study we investigated the efficacy and safety of a rapid-acting human insulin analogue （insulin Aspart） delivered with continuous subcutaneous insulin infusion （CSII） into Chinese diabetic patients. Methods A total of 21 patients with type 1 or type 2 diabetes were recruited for the 2-way cross-over, open-labeled trial, and then randomized to Group A （n=-10, treated with insulin Aspart） or Group B （n=11, treated with Novolin R）. Insulin Aspart and Novolin R were administered by CSII. Capillary glucose concentrations were measured at 8 time points, pre-prandial and postprandial, bedtime （10 pm）, midnight （2 am） every day during the treatment. Results The average capillary glucose profiles for the day were much better controlled in Group A than in Group B （P〈0.01）. The blood glucose levels were particularly better controlled in Group A than in Group B at pre-breakfast （（6.72±1.24） mmol/L vs （7.84±1.58） mmol/L, P=0.014）, post-breakfast （（8.96±2.41） mmol/L vs （11.70±3.11） mmol/L, P=0.0028）, post-supper （（8.15±2.10） mmol/L vs （10.07±2.36） mmol/L, P=0.008）, bed time （（7.73±1.72） mmol/L vs （9.39±.2.05） mmol/L, P=0.007） and midnight （（6.32±1.16） mmol/L vs （7.48±1.36） mmol/L, P=0.0049）. There was no significant difference in the frequency of hypoglycemic episodes between the two groups. Conclusion Insulin Aspart results in better control of blood glucose levels than regular human insulin （Novolin R） in diabetic patients during delivery by CSII.