What do patients prefer: insulin pumps or multiple daily injections and structured education?

Potential advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) include improved glycaemia, and reduced frequency and severity of hypoglycaemia. In our hospital, to be considered for CSII, patients must be using MDI, and then undergo a Dose Adjustment For Normal Eating (DAFNE) structured education course. We reviewed the records of the 21 patients with type 1 diabetes who had sequentially undergone MDI, then DAFNE and are now treated with CSII. HbA1c improved as patients increased the intensity of the management of diabetes despite reductions in total daily insulin dose. Patients did a similar number of home blood glucose tests per day and spent a similar amount of time managing their diabetes. Contacts with health care team members were the same for all modalities in the first three months but reduced for those on MDI with or without having completed a structured education course, while contacts with the health care team remained higher on pumps. Patients were generally satisfied with all modalities of treatment and would recommend each modality. The input into the management of diabetes from both patients and health care professionals remained high even after the initial stages of being commenced on CSII therapy. This reflects the additional input needed in assessing the various basal rates and other ratios. However, patient preference was in favour of pumps in this select group who had sequentially experienced all three options. Copyright © 2011 John Wiley & Sons.