Estudo clínico aberto não randomizado do tratamento do diabetes mellitus tipo 1 com bomba de infusão subcutânea contínua de insulina e insulina lispro

Abstract

Chronically descompensated patients with diabetes Type 1 have an increased susceptibility to microvascular (retinopathy and nephropaty) and neuropathic diabetic complications. Over the last decade it has been emphasized a strict control of diabetes as a goal to achieve. New technology carne about as powerful tool to improve this control, like insulin analogs (lispro and aspart) which have a faster initial and less prolonged actions and smaller and modern insulin pumps, which allows a continuous subcutaneous insulin infusion. Others therapeutics modalities like multiple regular or lispro insulin administration during the day (3 times) and NPH at supper were also remarkable. They tried to simulate a physiologic insulin secretion as close as possible, like a non diabetic person. Others factors in the last decade also demonstrated the importance of liome blood glucose self monitoration and a diet program based not in caloric counting but in carbohydrate counting as fundamental elements to improve glycemic control. . . In the middle of 1998, for the First time, continuous subcutaneous insulin pumps were available in Brazilian market. In this paper we studied the value of CSII plus lispro insulin in 17 patients with diabetes type 1 for a period of 18 montlis. Some biochemical and clinicai aspects of the disease were studied before and after 18 months in use of CSII. These include glycosylated 65 hemoglobin, weight, body mass index, the relationsliip between insulin and weight, amount of insulin used related to food and in continuous subcutaneous infusion not related to food . We compared the results of these 17 patients in CSII witli a heterogeneous group of 21 patients in conventional insulin therapy or in multiple insulin injections and with a homogeneous group of 12 diabetic type 1 in multiple insulin dose a day. After 18 months patients treated by CSII were better controlled based on the signifícant decrease of HbAlc levei (P< 0,05). In those patients there were a signifícant reduction in the Insulin/weigh ratio (P< 0,05) and this fact point to a better use of insulin related to feeding. Tliis was observed by the signifícant decrease bolus/basal ratio after 18 months, when compared to R or LP/NPH ratio before treatment (P< 0,05). Comparing to patients treated either conventionally or by MDI, diabetics treated by CSII showed both a better HbAlc levei (P< 0,05) and insulin /weight ratio. (P< 0,017). During the studied period there was no report of either severe hypoglycemia or ketoacidosis in any group of patients. We didn’t observed any local or systemic infection due to continuous subcutaneous insulin infusion. Concluding, CSII is effective and safe in the treatment of insulin-dependent diabetes mellitus.