Consequences of delayed pump infusion line change in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion☆☆☆★
Received 9 July 2008; received in revised form 16 February 2009; accepted 19 March 2009. published online 24 April 2009.
Abstract
Objective
To systematically investigate the effect of lack of adherence to the recommended change in insulin pump infusion line use beyond 48 h and determine whether the type of insulin made a difference.
Research design and methods
This was a double-blind, randomized, crossover trial with 20 patients with diabetes mellitus I using insulins aspart and lispro without a line change for up to 100 h. Using retrospective continuous glucose monitoring, we analyzed the average glucose over the day. Changes in serum 1,5-anhydroglucitol, carboxymethyllysine, and free 15-F2t isoprostane were also studied.
Results
From Day 2 to Day 5 of the pump line use, the daily average glucose level increased from 122.7 to 163.9 mg/dl (P<.05), fasting glucose from 120.3 to 154.5 mg/dl (P<.05), postprandial glucose from 114.6 to 172.1 mg/dl (P<.05), and the daily maximum glucose from 207.7 to 242.8 dl (P<.05 for the trend). Time period that the glucose was >180 mg/dl increased from 14.5% to 38.3% (P<.05). Loss of control occurred despite increase in total daily insulin dose from 48.5±11.8 to 55.3±17.9 U (P=.05). There was no difference in loss of control between insulin types, and biomarkers measured did not change significantly.
Conclusions
The insulin pump infusion should be changed every 48 h in patients using continuous subcutaneous insulin infusion (CSII), to avoid loss of glycemic control. In the short-term, this loss of glycemic control has no impact on oxidative stress and glycation.
cSchool of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
dDepartment of Anesthesiology, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA
Corresponding author. Tulane University Health Sciences Center, 1430 Tulane Avenue, SL- 53, New Orleans, LA 70112, USA. Tel.: +1 504 988 5044; fax: +1 504 988 6271.
☆☆ Disclosure: Ajay Rao, MD, Haytham Kawji, MD, Lillian Yau, PhD, have nothing to disclose. Dr. Vivian Fonseca has served as a consultant to Minimed, Novonordisk, and Eli Lilly.
★ This study was funded by Novonordisk through an unrestricted grant to Tulane University. This study was also supported in part by NIH Grants # 5M01RR05096 and RR-00827 in support of the General Clinical Research Center from the Division of Research Resources, National Institutes of Health (GCRC), and NIH/NIDDK P30 DK048520 (Mass Spectrometry Core). Diabetes research at Tulane University Health Sciences Center is supported in part by Susan Harling Robinson Fellowship in Diabetes Research and the Tullis-Tulane Alumni Chair in Diabetes. Dr. Fonseca is funded in part by NIH (ACCORD, TINSAL-2D), ADA, and the Tullis-Tulane Chair of Diabetes. Dr Thethi and the project described were supported by Award Number K12HD043451 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development or the National Institutes of Health.
ABSTRACT