Clinic Study On Insulin Pump Curing Type 2 Diabetes Mellitus

Diabetes is a common, frequently-occurring disease. Type 2 diabetes accounts for the vast majority of people with diabetes (about 95%). Diabetes mellitus is a group of metabolic diseases characterized by chronic high blood glucose. Hyperglycemia is due to defects in insulin secretion and insulin action. Its acute and chronic complications have Seriously endangered human health.For our clinicians, how to use limited health care resources prevent the diabetes development in high-risk groups, to control diabetic patients'blood glucose in an ideal range, to reduce the occurrence of acute and chronic complications,to Improve the long-term prognosis and the quality of life of patients, is our common goal.The importance of intensive therapy is increasingly being recognized. Conventional intensive insulin treatment was commonly used. Insulin pump mimics human pancreatic insulin secretion, and made up of oral hypoglycemic agents and insulin pen injection flaws.OBJECTIVE1. Comparison of the efficacy and safety of conventional intensive insulin therapy and insulin pump in the treatment of type 2 diabetes.2. Evaluation of the two treatment compliance .RESEARCH DESIGN AND METHODSSubject( patients inclusion/exclusion criteria): Experiments were performed in type 2 diabetic patients with poor blood glucose control (defined as FPG> 8.0mmol/L, 2 hours postprandial blood glucose> 11.1mmol/L) giving inpatient treatment in the department of Endocrinology & Metabolism of China-Japan union hospital from January 2006 to January 2008, excluding patients with liver dysfunction,heart dysfunction,renal dysfunction,type 1 diabetes,serious infection,use of hormone,DKA,hyperosmolar nonketotic diabetic coma,polycystic ovarian syndrome,and other diseases affecting glucose metabolism.Research design:Recorded basic information,such as name,gender,age,blood glucose monitoring,daily insulin dosage,triglycerides,and height,weight,waist circumference,BMI,WHR before and after the treatment.Diabetes education program, diet control, exercise training was carried out in patients. Insulin dosage was based on previous dosage of insulin,blood glucose and weight et al. According to the daily blood glucose detection ,adjusted insulin dosage. CSII group, 50 % of insulin dosage was for bolus before three meals, 50% for the basal rate. MDI group used the humapen (Lilly Insulin Prefilled Pen)to subcutaneous inject Humulin R before three meals,Humulin N before sleep. The criteria was up to: FPG <6.1 mmol / L, non-fasting blood glucose <= 8.0 mmol/L on two consecutive days. When blood sugar was in the target range,we recorded blood sugar,hypoglycemia frequency,time and symptoms,insulin injection site reactions,the breakdown of pumps.Processing and testing of blood samples:Venous plasma glucose and other biochemical markers were measured by automatic biochemical meter. Capillary blood glucose was measured by the Surestep.Plus glucometer and hospital special test paper.Data Statistical analysis:All the measurement data was presented as means±SD,then conducted homogeneity of variance test and t test. Count data used the chi-square test or fisher's test.All the data was analyzed using SPSS 10.0 program. As for two side test on a line, the eminent levelα=0.05 should be accepted.RESULT1. Comparison of baseline data:The gender,age,course of disease,and BMI,WHR,HbA1c,TG,FPG,2-hour postprandial blood sugar before treatment have no statistical difference(P>0.05).2.Blood glucose: Target blood glucose could be achieved by both CSII and MDI, ultimately. CSII group showed a better blood glucose control than MDI group. FPG and the blood glucose after three meals have reached statistical significance (p< 0.05).The number of patients with insulin alone achieving target blood glucose have statistical difference(P<0.05).3.Blood sugar fluctuations: was measured by MAGE, CSII group had less glucose fluctuation than MDI group in all day.4.The time of reaching target blood glucose value: The CSII group of patients have passed the criteria for 7.5±1.7 days, that of the MDI group is 12.7±1.1 days.CSII can achieve the blood glucose control faster, which has shown the statistically significant difference (P <0.01).5.Insulin dosage when glucose is in target range: CSII group was 39.8±5.3u/d, while that for the MDI group was 45.2±6.6u/d. It reached significant difference (P<0.05).6.Comparison on insulin dose and glucose between before and after treatment: Humulin 70/30 was used in 16 patients both before and after CSII treatment. The insulin (Humulin 70/30)dosage between before and after CSII treatment has no significant difference (P>0.05), while the average blood glucose level of the day had improved, having statistic significance(P<0.05).7.Incidence of hypoglycemic episodes : There was a decrease in the recorded history of moderate hypoglycemia in CSII group (0.06 vs 0.13 events/patient-day; P < 0.05). Both of the two group had no serious hypoglycemic incidents occurred.8.Comparison on body weight, BMI,waist circumference, hip circumference, WHR between before and after treatment: Both of the two group had shown no significant difference.9.The cost of treatment: The average daily cost per person from beginning of treatment to the patients discharged was calculated. The cost of CSII therapy was 5 times of MDI.10.Side-effects and compliance: In the CSII group-a total of 51 patients with type 2 diabetes, 1 suspended CSII therapy for economic reasons, 3 reached target glucose range with oral hypoglycemic agents, only 9 of them that could insist the long-term use of insulin pump therapy, 12 had a erythema ( < 3 mm diameter) at the insulin injection site(not associated with subcutaneous nodules and lipohypertrophy), 2 reinserted the indwelling subcutaneous catheter. In the MDI group—a total of 56 patients with type 2 diabetes,no withdrawal of treatment, 15 could not meet these criteria on insulin therapy alone, 28 felt the injection pain. None in the both group had infection or fester. The compliance of CSII and MDI therapy in inpatients has no differene.Conclusion1. CSII is an effective means of intensive treatment, can control blood glucose more effectively and more rapidly, stabilize the fluctuations of blood sugar,reduce the occurrence of hypoglycemia, reduce the amount of insulin required to maintain a normal or near normal glucose level.2. After short-term CSII therapy, the blood glucose of the patients with type 2 diabetes can be control easier.3. CSII can improve the quality of life of patients, majority of patients can not receive long-term CSII therapy because of the expense, but could be one of the ideal treatment programs of inpatient with poor glycemic control.