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Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness

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Background: Managing Diabetes With Insulin Therapy and Glycemic Control

Evidence has shown that tight glycemic control with intensive insulin therapy reduces the risk of the microvascular and macrovascular complications of diabetes. The management strategy depends on the type of diabetes. For patients with type 1 diabetes, daily insulin therapy is vital. For patients with type 2 diabetes, treatment approaches include lifestyle modifications and/or oral medications; insulin therapy might be required in some patients.

One approach to intensive insulin therapy is to administer multiple daily injections of insulin (MDI). MDI consists of physiological basal and meal-time (bolus or prandial) insulins that, when used together, mimic normal pancreatic function (peakless basal insulin secretion, rapid release of insulin in response to meals, and rapid resolution of the bolus insulin peak). A second approach to intensive insulin therapy is continuous subcutaneous insulin infusion (CSII) via a pump, which provides another means to deliver insulin in a more physiological manner.

While tight glycemic control via intensive insulin therapy lowers the risk of diabetic complications, it can increase the risk of hypoglycemia. Severe hypoglycemia, which can be life threatening, is an episode that requires treatment assistance from another person to resolve symptoms. Nonsevere hypoglycemia may be symptomatic, but individuals are able to correct it without assistance from others. Both types of hypoglycemic episodes can be a source of significant distress and anxiety to patients and a barrier to achieving tight glycemic control. Finally, intensive insulin therapy can also lead to weight gain, due to more efficient fuel utilization and/or overtreatment of hypoglycemic episodes.