Abstract

Switching from MDI to CSII - Assessment of Qualitative and Quantitative Impact on Self-Management of T1DM Patients

Introduction: Type 1 diabetes (T1DM) patients depend entirely on exogenous insulin. Most patients require multiple daily injections (MDI) for optimal control. Continuous Subcutaneous Insulin Infusion (CSII) is an effective alternative to MDI, usually affording better glycaemic control. Though many studies report these clinical benefits as well as the technical problems encountered with CSII, very few studies report patient / family perceptions about using CSII. Present study was undertaken to assess the impact of switching from MDI to CSII on self-management of T1DM patients. It focuses mainly on patient perceptions and concerns about shifting to CSII and the coping strategies they evolve to handle these concerns. Clinical outcome and problems encountered-the basis of these concerns - were also recorded. Methodology: Twenty Type 1 diabetes patients using insulin pump were interviewed in depth to understand their perceptions and concerns while shifting to CSII. A structured questionnaire was used to gather quantitative data regarding impact on clinical outcome and the problems encountered. Results: Our patients showed statistically significant improvement in HbA1c along with reduction in the total daily dose on shifting to CSII. Frequency of hypoglycaemia also reduced. However, ‘silent blocks’ experienced by 56% of patients were expressed as the most alarming technical problem with grave clinical and psychological implications. Convenience emerged as a major advantage of switching to CSII (80%) and prompted them to develop coping strategies to overcome the problems encountered.