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Continuous intraperitoneal insulin linked with better quality of life

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients report higher quality of life with continuous intraperitoneal versus subcutaneous insulin, Dutch investigators have found.

The researchers had previously reported that continuous intraperitoneal insulin allows better glycemic control compared to intensified subcutaneous insulin therapy (see Reuters Health story, August 11, 2009).

Their new paper reports on health-related quality of life outcomes and treatment satisfaction in 23 adults with type 1 diabetes who enrolled in a randomized cross-over trial of the two approaches. Patients had 6 months of intensive subcutaneous insulin followed by 6 months of peritoneal infusion, or vice versa. The subcutaneous insulin was given either continuously or via injection – whatever the patient was doing before enrollment.

In their article, published online February 25th in Diabetes Care, lead author Dr. Susan J. Logtenberg, from Isala Clinics, Zwolle, and colleagues write that scores on six subscales of the 36-item Short-Form Health Survey were significantly higher with peritoneal infusion. The only exceptions were in the social functioning and bodily pain domains.

On the World Health Organization-Five Well-Being Index, significantly fewer patients had a score below 50 — an indication of poor emotional well-being – after peritoneal treatment (6 vs 13, p = 0.02).

Moreover, patients perceived significantly fewer hypoglycemic and hyperglycemic events during their peritoneal infusion phase, leading to greater treatment satisfaction.

As the authors point out, patients preferred the peritoneal approach despite the fact that it requires hospital admission and surgery to insert the pump. It also costs more than twice as much as continuous subcutaneous insulin infusion.

“Continuous intraperitoneal insulin infusion should be (re)considered as a treatment option, at least when satisfactory results of treatment are not reached with subcutaneous intensive insulin treatment regimens,” Dr. Logtenberg’s team concludes.

Medtronic Europe, which sells insulin pumps, provided an unrestricted grant to the authors.

Diabetes Care 2010.