The use of multiple daily injections versus insulin pump therapy for HgbA1c reduction in patients with insulin-dependent type 2 diabetes.

BACKGROUND: More than 35 million Americans live with type 2 diabetes (T2D), resulting in the need for newer strategies and technologies to manage the disease. Insulin pump therapy (IPT) has historically been reserved for type 1 diabetes, although emerging data demonstrates improved glucose outcomes for patients with T2D using IPT. PURPOSE: To measure the change in HgbA1c in patients with T2D after changing therapy from multiple daily injections (MDI) to continuous subcutaneous insulin infusion through IPT. METHODOLOGY: A retrospective comparison study was conducted by reviewing the electronic medical record of patients with T2D, older than 18 years, who had been on multiple daily insulin injections for at least 1 year, followed by IPT for at least 1 year. RESULTS: One hundred seventy-one patients met the inclusion criteria. There was a statistically significant reduction in mean HgbA1c from 9.6% to 7.6%. CONCLUSION: Insulin pump therapy may result in lower HgbA1c levels for T2D not at goal on MDI. IMPLICATIONS: Patients on multiple daily insulin injections who are not at goal should be considered for IPT.

Validation of bioimpedance spectroscopy to assess acute changes in hydration status.

PURPOSE: To validate bioimpedance spectroscopy (BIS) as a field method for measuring small, acute changes in extracellular water (ECW) during a fluid fast/rehydration manipulation. METHODS: Seventeen young adults (15 female, 2 male) participated in a 4-d fluid fast/rehydration protocol designed to induce acute changes in ECW. ECW change (DeltaECW), measured by bioimpedance spectroscopy (BIS-DeltaECW), was compared with DeltaECW, measured by bromide dilution (Br-DeltaECW), and change in body weight (DeltaBW). RESULTS: Regardless of hydration status, BIS-DeltaECW and Br-DeltaECW were similar; during dehydration, the mean difference between these two methods was 0.16 kg (P=0.61), and during rehydration, the mean difference was 0.58 kg (P=0.06). Assuming that DeltaECW=DeltaBW, DeltaECW as estimated from DeltaBW differed significantly from Br-DeltaECW, but not from BIS-DeltaECW. In addition, BIS-DeltaECW correlated significantly with DeltaBW (r=0.57 and 0.65 during dehydration and rehydration, respectively). However, the magnitude of DeltaECW impacted the accuracy of BIS-DeltaECW because BIS measures tended to overestimate DeltaECW at values between 0.0 and 1.0 kg and to underestimate changes at values above 1.0 kg. CONCLUSION: These findings suggest that BIS provides an accurate estimate of DeltaECW compared with bromide dilution during short-term changes in hydration.