The egg or the chicken? Should good compliance to multiinjection insulin therapy be a criterion for insulin pump therapy, or does insulin pump therapy improve compliance?

We studied two groups of patients with type 1 diabetes. Group A consisted of 11 patients, 16.2 3.2 years of age, from northwestern Sicily; group B consisted of 8 patients, 19.8 4.3 years of age, from the Naples area. On starting CSII, HbA1c% was lower in group A (7.84% 1.53%) than in group B (9.28% 1.56%). Hence, group A had better compliance to therapy. After 6 months of CSII, HbA1c remained virtually unchanged in group A (7.63% 1.25%), whereas it was significantly reduced in group B (7.83% 1.21%, P .06). In group A, both the mean amplitude of glycemic excursion (MAGE) and the means of daily glycemic difference (MODD) decreased, whereas in group B, the MAGE increased but not the MODD. The increase in MAGE may be explained by a reduction in glycemic levels at different times in group B patients. Therefore, good glycemic control and compliance persisted unchanged in group A, whereas glycemic control improved in group B. These data suggest that even patients with poor control at a high risk of microvascular complications may benefit from CSII. The cost of greater use of CSII may be balanced by a reduced need to treat microvascular complications