Benefits Of Transient Continuous Subcutaneous Insulin Infusion To The Poorly Controlled Type 2 Diabetic Patients With Multiple Daily Insulin Injection

Objective:To investigate the benefits of transient continuous subcutaneous insulin infusion(CSâ…¡)to the poorly controlled Type 2 diabetic patients with multiple daily insulin injection(MDâ…¡).Methods:In a prospective observational study,ten poorly controlled type 2 diabetic patients who had accepted insulin therapy for more than one year with insulin dose exceeding 40 U per day participated in the study.The basic glycosylated hemoglobin AlC(HbAlc)was＞7.5%,and fasting blood glucose (FBG)was＞8 mmol/L in all patients.They were treated with CSâ…¡using insulin aspart for 10 to 14 days,aimed at FBG＜6.0 mmol/L and 2 hours postprandial glucose(2hPG)＜10 mmol/L.Before and after CSâ…¡therapy,FBG,2hPG, glucosylated serum protein(GSP)and HbA₁c were measured,and continuous glucose monitoring system(CGMS)was performed.β-cell function was assessed by intravenous glucose tolerance test(â…£GTT).Insulin resistance was measured by using hyperinsulinaemic euglycaemic clamp in which the glucose infusion rate (GIR)was the major index.Results:Ten patients(M/F=6:4,aged 42 to 59 years old)with 7 to 19 years of diabetes using insulin therapy for 1 to 5 years(daily injection of insulin for 2 to 4 times,dosage 40～72 U)participated in the study.After CSâ…¡treatment,average FBG decreased from 12.4±3.24 mmol/L to 5.67±0.635 mmol/L(P＜0.01),2hPG decreased from16.9±3.47 mmol/L to 8.61±1.11 mmol/L(P＜0.01),GSP decreased from 316.7±123.2μmol/L to 243.1±75.9μmol/L(P＜0.05),and HbA₁c decreased from 10.4±1.78%to 8.94±1.03%(P＜0.05).However,there is not C-peptide peak before and after CSâ…¡treatment.The area under the curve(AUC)of C-peptide during IVGTT were 27.89±16.36 ng·min·ml^-1and 29.15±16.28 ng·min·ml^-1(P＞0.05)from 0 to 12 min,73.19±39.01 ng·min·ml^-1and 76.45±43.55 ng·min·ml^-1(P＞0.05)from 0 to 30 min,378.97±208.44 ng·min·ml^-1and 399.08±222.97 ng·min·ml^-1(P＞0.05)from 0 to120 min before and after CSâ…¡ treatment,respectively.The GIR were 4.73±1.84 mg·kg1^-1·min^-1and 5.12±1.70 mg·kg^-1·min^-1before and after treatment(P＞0.05),respectively.Conclusions:CSâ…¡dramatically improves hyperglycemia in Type 2 diabetic patients who were poorly controlled with MDâ…¡within 10 to 14 days.However, transient CSâ…¡therapy could not improve insulin resistance andβ-cell function.