Management and efficacy of intensified insulin therapy starting in outpatients

Diabetic patients under multiple injection insulin therapy (i.e.,
intensified insulin therapy, IIT) usually start this treatment
during hospitalization. We report here on the logistics, efficacy,
and safety of IIT, started in outpatients. Over 8 months, 52 type I
and type II diabetics were followed up whose insulin regimens
consecutively had been changed from conventional therapy to IIT.
Two different IIT strategies were compared: free mixtures of
regular and intermediate (12 hrs)-acting insulin versus the basal
and prandial insulin treatment with preprandial injections of
regular insulin, and ultralente (24 hrs-acting) or intermediate
insulin for the basal demand. After 8 months HbA1 levels had
decreased from 10.6%±2.4% to 8.0%±1.3% (means±SD). There was no
difference between the two regimens with respect to metabolic
control; but type II patients maintained the lowered HbA1 levels
better than type I patients. Only two patients were hospitalized
during the follow-up time because of severe hypoglycemia. An
increase of body weight due to the diet liberalization during IIT
became a problem in one-third of the patients. Our results suggest
that outpatient initiation of IIT is safe and efficacious with
respect to near-normoglycemic control. Weight control may become a
problem in IIT patients.