***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Multiple daily injection ( MDI ) therapy of bolus insulin aspart and basal insulin glargine was compared with continuous subcutaneous insulin infusion ( CSII ) with aspart in type 1 diabetic patients previously treated with CSII . RESEARCH DESIGN AND METHODS One hundred patients were enrolled in a r and omized , multicenter , open-label , crossover study . After a 1-week run-in period with aspart by CSII , 50 subjects were r and omly assigned to MDI therapy ( aspart immediately before each meal and glargine at bedtime ) and 50 subjects continued CSII . After 5 weeks of the first treatment , subjects crossed over to the alternate treatment for 5 weeks . During the last week of each treatment period , subjects wore a  continuous glucose monitoring system  for 48 - 72 h. RESULTS Mean serum fructosamine levels were significantly lower after CSII therapy than after MDI therapy ( 343 + /- 47 vs. 355 + /- 50 micromol/l , respectively ; P = 0.0001 ) . Continuous glucose monitoring profiles over a 24-h time period showed that glucose exposure was 24 and 40 % lower for CSII than MDI as measured by area under the curve ( AUC ) glucose > /=80 mg/dl ( 1,270 + /- 742 vs. 1,664 + /- 1,039 mg . h . dl(-1 ) ; P < 0.001 ) and AUC glucose > /=140 mg/dl ( 464 + /- 452 vs. 777 + /- 746 mg . h . dl(-1 ) , CSII vs. MDI , respectively ; P < 0.001 ) . Similar percentages of subjects reported hypoglycemic episodes ( CSII : 92 % , MDI : 94 % ) and nocturnal ( 12:00 a.m. to 8:00 a.m. ) hypoglycemic episodes ( CSII : 73 % , MDI : 72 % ) . Major hypoglycemia was infrequent ( CSII : two episodes , MDI : five episodes ) . CONCLUSIONS In a trial of short duration , CSII therapy with insulin aspart result ed in lower glycemic exposure without increased risk of hypoglycemia , as compared with MDI with insulin aspart and glargine Urinary albumin was studied in 45 patients with insulin-dependent diabetes in a 4-year prospect i ve r and omized trial , comparing continuous sc insulin infusion ( CSII ) , multiple insulin injections , and conventional treatment with twice daily injections . Strict blood glucose control was obtained with CSII and multiple injections , better than with conventional treatment ( 2P less than 0.01 ) : mean glycosylated haemoglobin ( % HbA1 + /- SEM ) after 4 years : CSII 9.0 + /- 0.4 % ; multiple injections 9.4 + /- 0.4 % ; conventional treatment 10.5 + /- 0.5 . A total of 696 24-h urine specimens were collected . After 4 years of CSII from the time of r and omization , urinary albumin excretion was reduced ( 26 + /- 5 to 16 + /- 4 mg/24 h , mean + /- SEM , 2P less than 0.01 ) , when compared with conventional treatment ( 2P = 0.01 ) , when compared with conventional treatment ( 2P = 0.01 ) where no change was observed ( 21 + /- 4 to 22 + /- 6 mg/24 h , n.s . ) . The reduction observed during  multiple injection treatment was not significant ( 17 + /- 3 to 14 + /- 3 mg/24 h ) . Long-term near-normoglycaemia may influence the mechanisms leading to albuminuria in diabetes , if introduced at an early stage of the disease AIMS The goal of the study was to determine whether continuous subcutaneous insulin infusion ( CSII ) differs from a multiple daily injection ( MDI ) regimen based on neutral protamine hagedorn ( NPH ) as basal insulin with respect to glycaemic control and quality of life in people with Type 1 diabetes . METHODS The 5-Nations trial was a r and omized , controlled , crossover trial conducted in 11 European centres . Two hundred and seventy-two patients were treated with CSII or MDI during a 2-month run-in period followed by a 6-month treatment period , respectively . The quality of glycaemic control was assessed by HbA(1c ) , blood glucose values , and the frequency of hypoglycaemic events . For the evaluation of the quality of life , three different self-report question naires have been assessed . RESULTS CSII treatment result ed in lower HbA(1c ) ( 7.45 vs. 7.67 % , P < 0.001 ) , mean blood glucose level ( 8.6 vs. 9.4 mmol/l , P < 0.001 ) and less fluctuation in blood glucose levels than MDI ( + /- 3.9 vs. + /- 4.3 mmol/l , P < 0.001 ) . There was a marked reduction in the frequency of hypoglycaemic events using CSII compared with MDI , with an incidence ratio of 1.12 [ 95 % confidence interval ( CI ) : 1.08 - 1.17 ] and 2.61 ( 95 % CI : 1.59 - 4.29 ) for mild and severe hypoglycaemia , respectively . The overall score of the diabetes quality of life question naire was higher for CSII ( P < 0.001 ) , and an improvement in pump users ' perception of mental health was detected when using the SF-12 question naire ( P < 0.05 ) . CONCLUSION CSII usage offers significant benefits over NPH-based MDI for individuals with Type 1 diabetes , with improvement in all significant metabolic parameters as well as in patients ' quality of life . Additional studies are needed to compare CSII with glargine- and detemir-based MDI Summary We investigated in a r and omized , prospect i ve study the influence of improved blood glucose control during 2 - 3 years in young insulin-dependent diabetic ( IDDM ) patients with microalbuminuria , which is indicative of early nephropathy . Patients were r and omized either to intensive treatment by continuous subcutaneous insulin infusion ( CSII ) ( n = 9 ) or CT ( n = 9 ) . Kidney biopsies were taken at baseline and after 26 - 34 months . End points were structural changes in the glomeruli . Sensitive , quantitative , mor-phometric methods were used . The blood glucose control improved significantly ( p = 0.01 ) during the study in the CSII-group as glycated haemoglobin ( HbAlc ) fell from 10.1 % ( [ 95 % CI ] 8.9 - 11.3 ) to 8.6 % ( 7.9 - 9.2 ) , but not in the CT-group , 10.1 % ( 8.3 - 11.9 ) vs 9.7 % ( 8.7 - 10.8 ) . Mean HbAlc during the study period was significantly lower in the CSII-group than in the CT-group , 8.7 % ( 8.1 - 9.3 ) vs 9.9 % ( 8.5 - 11.3 ) , p = 0.04 . Basement membrane thickness ( BMT ) increased in both groups , most ( CT vs CSII , p = 0.03 ) in the CT-group : 140 nm ( 50 - 230 ) vs CSII : 56 nm ( 27 - 86 ) . In the CT-group only an increase was seen in matrix/mesan-gial volume fraction ( p = 0.006 ) and matrix star volume ( p = 0.04 ) . Furthermore , a positive correlation between mean HbAlc during the study and change from baseline in BMT ( r = 0.70 , p = 0.001 ) and ma-trix/glomerular volume fraction ( r = 0.33 , p = 0.09 , NS ) was demonstrated . Albumin excretion rate correlated significantly to BMT and most of the matrix parameters . The present study shows that during a period of only 2.5 years , a close relationship between the level of mean blood glucose and progression of glomerular morphological changes in early diabetic nephropathy can be demonstrated . [ Diabetologia ( 1994 ) 37 : 483 - 490 OBJECTIVE To evaluate glycemic control , hypoglycemic events , and quality of life in patients treated with continuous subcutaneous insulin infusion ( CSII ) and multiple daily insulin injection ( MDI ) , with insulin lispro as the principal insulin . RESEARCH DESIGN AND METHODS This clinical trial enrolled 27 patients with type 1 diabetes . They were r and omly assigned to CSII ( n = 13 ) or MDI ( n = 14 ) treatment regimens . Glycemic control ( HbA(1c ) level ) was the primary outcome and was measured monthly for 9 months . Secondary outcomes were patient reports of hypoglycemic events ( recorded monthly for 9 months ) and quality of life assessed at 9 months using the Diabetes Quality of Life ( DQOL ) question naire . RESULTS A significant decrease in HbA(1c ) from baseline was shown for both groups . However , the overall treatment effect ( CSII - MDI ) for HbA(1c ) was + 0.08 % ( 95 % CI -0.23 to + 0.39 , P > 0.10 ) . This was significantly less than the a priori limit of + /-0.5 % ( P = 0.004 ) . The relative treatment effect ( [ CSII - MDI]/MDI ) for the overall number of hypoglycemic events was + 9 % ( 95 % CI -37 to + 87 , P > 0.10 ) . There were no statistically significant differences between treatment groups for any of the DQOL subscales . CONCLUSIONS No statistically significant differences in glycemic control , reported hypoglycemic events , or quality of life were found in this study . Furthermore , a clinical ly significant difference of more than + /-0.5 % HbA(1c ) between the two regimens can be confidently ruled out . We conclude that the choice of intensive insulin therapy should be a matter of patient preference , consistent with lifestyle OBJECTIVE Compare the efficacy , safety , and patient satisfaction of continuous subcutaneous insulin infusion ( CSII ) therapy with multiple daily injection ( MDI ) therapy for patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 132 CSII-naive type 2 diabetic patients were r and omly assigned ( 1:1 ) to CSII ( using insulin aspart ) or MDI therapy ( bolus insulin aspart and basal NPH insulin ) in a multicenter , open-label , r and omized , parallel-group , 24-week study . Efficacy was assessed with HbA(1c ) and eight-point blood glucose ( BG ) profiles . Treatment satisfaction was determined with a self-administered question naire . Safety assessment s included adverse events , hypoglycemic episodes , laboratory values , and physical examination findings . RESULTS HbA(1c ) values decreased similarly for both groups from baseline ( 8.2 + /- 1.37 % for CSII , 8.0 + /- 1.08 % for MDI ) to end of study ( 7.6 + /- 1.22 % for CSII , 7.5 + /- 1.22 % for MDI ) . The CSII group showed a trend toward lower eight-point BG values at most time points ( only significant 90 min after breakfast ; 167 + /- 48 vs. 192 + /- 65 mg/dl for CSII and MDI , respectively ; P = 0.019 ) . A total of 93 % of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience , flexibility , ease of use , and overall preference . Safety assessment s were comparable for both treatment groups . CONCLUSIONS Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes . Patients with type 2 diabetes can be trained as out patients to use CSII and prefer CSII to injections , indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes OBJECTIVE To compare the efficacy of 2 intensified insulin regimens , continuous subcutaneous insulin infusion ( CSII ) and multiple daily injections ( MDI ) , by using the short-acting insulin analog lispro in type 1 diabetic patients . RESEARCH DESIGN AND METHODS A total of 41 C-peptide-negative type 1 diabetic patients ( age 43.5+/-10.3 years ; 21 men and 20 women , BMI 24.0+/-2.4 kg/m2 , diabetes duration 20.0+/-11.3 years ) on intensified insulin therapy ( MDI with regular insulin or lispro , n = 9 , CSII with regular insulin , n = 32 ) were included in an open-label r and omized crossover study comparing two 4-month periods of intensified insulin therapy with lispro : one period by MDI and the other by CS 
    Output:
    
Total daily insulin requirements were lower with CSII than with MDI therapy .
In patients with type 2 diabetes mellitus , CSII and MDI treatment showed no statistically significant difference for HbA1c .
The incidence of mild hypoglycaemic events was comparable between the treatment groups .
Conclusions /interpretationCSII therapy in adults and adolescents with type 1 diabetes mellitus result ed in a greater reduction of glycated haemoglobin , in adult patients without a higher rate of hypoglycaemia .
No beneficial effect of CSII therapy could be detected for patients with type 2 diabetes mellitus