Continuous subcutaneous insulin infusion (CSII) in the Veneto region: efficacy, acceptability and quality of life.

Aim: To study the effect of continuous subcutaneous insulin infusion (CSII) on metabolic control and well-being in patients with Type 1 diabetes.
Methods: Efficacy, safety and interference with everyday life associated with CSII were studied retrospectively in 138 diabetic patients from the Veneto region treated for 7.4 +/- 0.4 years.
Results: Glycosylated haemoglobin decreased during the first year of CSII from 9.3 +/- 0.2% to 7.9 +/- 0.1% (P < 0.0001), and then remained unchanged. Serious hypoglycaemia decreased from 0.31 +/- 0.07/year to 0.09 +/- 0.02/year (P < 0.003), as did ketoacidosis (from 0.41 +/- 0.12/year to 0.11 +/- 0.03/year, P < 0.013). During the first year of therapy daily insulin requirement decreased from 49 +/- 1 to 42 +/- 2 U/day (P < 0.0001) and did not change thereafter. The number of out-patient consultations and hospital admissions per year also decreased significantly. CSII was associated with a progressive increase of body weight (P < 0.05) and with 0.2 +/- 0.04 infections/patient per year at the infusion site. Infection was rated as mild in 72%, moderate in 18%, severe in 10%. Patients reported that CSII improved metabolic control (71%), sense of well-being (41%), and allowed more freedom (40%). Quality of life, assessed using the DQOL, after 7 years of CSII was rated as good by patients (score of 73.0 +/- 1.8 on a scale from 0 to 100).
Conclusions: This retrospective analysis suggests that CSII improves metabolic control in Type 1 diabetic patients, reduces hypoglycaemic and ketoacidotic events, is well accepted, allows a good quality of life and decreases out-patient consultations and hospital admissions.