**4.1 Single centre pilot study on metabolic effectiveness of CSII in PWD1 (1993–1998)**

Subjects: Thirteen PWD1 males and females were put on an insulin pump (Dahedi, H-Tron, Minimed) in the period of years 1993–1998 demonstrated that the continuous subcutaneous insulin infusion resulted as soon as in 72 days in a decrease of concentrations of HbA1c in blood (NGSP scale 9.3 0.46 vs 7.6 0.28 %, p < 0.05)

*Intensive Management of Type 1 Diabetes in Adults: One Centre Experience 1970–2022 DOI: http://dx.doi.org/10.5772/intechopen.108032*

**Figure 10.**

*The 16-point cBG profiles at the end of insulin regimen A in 36 PWD (A) and in 21 of them who reached the best BG values with regimen A (A-best). cBG values in the group A-best remain significantly higher than in a control group of 9 healthy men. See also Figure 11.*

**Figure 11.**

*The 16-point FIRI profiles at the end of insulin regimen A in 36 men (A-all) and in a control group of 9 healthy men. \* p < 0.05.*

(**Figure 23**), of total serum cholesterol (5.47 0.29 vs 4.85 0.19 mmol/l, p < 0.05) (**Figure 24**) and triacylglycerols (1.58 0.24 vs 1.13 0.15 mmol/l, p < 0.05). The total daily dose of insulin was reduced (47.8 2.75 vs 41.3 2.3 IU/d, p < 0.05) and the body mass did not change. An improved metabolic control was also found in a check-up 554 days later. There were no serious complications resulting from the usage of a pump.

In the third milenium, insulin pumps enable adaptation of basal rate up to 48 times per 24 h. Based on the biorhythm of insulin sensitivity and

## **Figure 12.**

*Frequency of fasting cBG concentrations at BG profiles in the course of respective regimen.*

### **Figure 13.**

*Preference of regimens A, B, C at the beginning, at the end of the in-patient period and after 8-week home therapy with self-selected regimen.*

## **Figure 14.**

*First insulin pens MADI (MAnual Device for Insulin) developed at Palacký University Olomouc in 1983–1990 [20, 21, 78] MADI 5/5 ml (above), MADI 7/2 ml—used in this study (middle), MADI 8/3 ml (below). Photo V. Kupčík, www.diabetesmuseum.cz.*

*Intensive Management of Type 1 Diabetes in Adults: One Centre Experience 1970–2022 DOI: http://dx.doi.org/10.5772/intechopen.108032*

**Figure 15.** *Promedos E 1, Siemens, Germany [115].*

**Figure 16.** *Dahedi Elektroniks, Netherlands.*

**Figure 17.** *H tron, Disetronic, Switzerland.*

**Figure 18.** *Medtronic-Minimed 506, CA, USA.*

*Type 1 Diabetes in 2023 - From Real Practice to Open Questions*

**Figure 19.** *Animas IR.*

**Figure 20.**

*Osobní Injektor, Institute of Physiology Prague, Kovo Brno, CR. Hundreds of pumps were widely used in Prague, Brno and Hradec Králové in the period of years 1984–1991 [108–112]. Photo V. Kupčík, www.diabetesmuseum.cz*

carbohydrate ratio and on our clinical experience with CGM-augmented CSII (**Figure 25**) [65, 98, 100, 103, 116], we have introduced a dynamic schedule of basal rates (**Figure 26**). This schedule we have used in PWD1 at the beginning of CSII therapy, to be adopted individually. Intensive conventional selfmonitoring or CGM or FGM are prerequisites for an effective CSII.

*Intensive Management of Type 1 Diabetes in Adults: One Centre Experience 1970–2022 DOI: http://dx.doi.org/10.5772/intechopen.108032*

## **Figure 22.**

*Paradigm 722, Sensor and transmitter, Minimed-Medtronic, CA, USA. These sensor-augmented pumps [116] opened the door for the effective application of CGM or FGM in metabolic control and prevention of late complications in PWD1.*

**Figure 23.**

*HbA1c (NGSP %) at baseline, after 72 d and 554 d on CSII n = 13.*
