Intensified insulin therapy in the type I diabetic adolescent: a controlled trial.

The effects of continuous subcutaneous insulin infusion (CSII), intensified conventional therapy (ICT), and a combination of CSII and ICT (CSII-ICT) on metabolic control were compared in a group of twenty type I diabetic adolescents who had previously failed to respond to twice-daily injections and home glucose monitoring. A marked improvement in control was observed when mean glycemia and glycosylated hemoglobin A1 (HbA1) were compared with conventional therapy (CT). In the course of CSII, a lower HbA1 (P less than 0.05) and mean capillary blood glucose (CBG) (P less than 0.04) were observed than during ICT and CSII-ICT. Acceptability of CSII was greater than that of ICT and CSII-ICT, with 50% of the patients opting for this therapy at the end of the 1-yr trial. The marked improvement of control observed under CSII for the group as a whole was maintained after 6 mo of completion of the study. Thus, it appears that in type I diabetic adolescents CSII is more effective and acceptable than ICT and CSII-ICT.