***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: BACKGROUND Continuous subcutaneous insulin infusion ( CSII ) is believed to decrease glycemic variability and clinical hypoglycemia compared with the multiple daily insulin ( MDI ) regimen . To compare the indices of glycemic instability between CSII and MDI , we analyzed the continuous glucose monitoring system ( CGMS ) ( Medtronic MiniMed , Northridge , CA ) profiles of a group of children with type 1 diabetes mellitus with history of frequent blood glucose ( BG ) fluctuations and hypoglycemia . PATIENTS AND METHODS Data from 14 ( nine girls , five boys ) patients ( 3.9 - 16.8 years old ) on CSII and 14 age- and sex-matched ( nine girls , five boys ) patients ( 3.9 - 16.0 years old ) on MDI with similar glycemic control ( hemoglobin A1c : 7.9 + /- 1.0 % vs. 7.9 + /- 1.5 % ) and body mass index ( BMI ) ( 20.1 + /- 4.3 vs. 19.9 + /- 4.1 kg/m(2 ) ) were evaluated by the CGMS . Mean BG ( MBG ) , absolute means of daily differences ( MODD ) , mean amplitude of glycemic excursion ( MAGE ) , and number of hypoglycemic events ( BG < 60 mg/dL ) for 48 h were calculated . RESULTS The MBG , MODD , MAGE , and number and mean duration of hypoglycemia events in the CSII group were similar to those in the MDI group . The MAGE had an inverse correlation with age ( CSII : r ( 2 ) = 0.52 , P = 0.003 ; MDI : r ( 2 ) = 0.29 , P < 0.04 ) and BMI ( CSII : r ( 2 ) = 0.38 , P < 0.02 ; MDI : r ( 2 ) = 0.71 , P < 0.0002 ) . However , there was a positive relationship between MAGE and bolus : basal insulin ratio in the CSII ( r ( 2 ) = 0.28 , P < 0.05 ) and MDI ( r ( 2 ) = 0.33 , P < 0.03 ) groups . Also , the MAGE had a positive correlation with frequency of hypoglycemic events in the CSII ( r ( 2 ) = 0.44 , P < 0.01 ) and MDI ( r ( 2 ) = 0.35 , P < 0.03 ) groups . CONCLUSIONS The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions , implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality 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 CSII .  Blood glucose ( BG ) was monitored before and after each of the 3 meals each day . RESULTS The basal insulin regimen had to be optimized in 75 % of the patients during the MDI period ( mean number of NPH injections per day = 2.65 ) . HbA1c values were lower when lispro was used in CSII than in MDI ( 7.89+/-0.77 vs. 8.24+/-0.77 % , P<0.001 ) . BG levels were lower with CSII ( 165+/-27 vs. 175+/-33 mg/dl , P<0.05 ) . The SD of all the BG values ( 73+/-15 vs. 82+/-18 mg/dl , P<0.01 ) was lower with CSII . The frequency of hypoglycemic events , defined as BG levels < 60 mg/dl , did not differ significantly between the 2 modalities ( CSII 3.9+/-4.2 per 14 days vs. MDI 4.3+/-3.9 per 14 days ) . Mean insulin doses were significantly lower with CSII than with MDI ( 38.5+/-9.8 vs. 47.3+/-14.9 U/day . respectively , P < 0.0001 ) . CONCLUSIONS When used with external pumps versus MDI , lispro provides better glycemic control and stability with much lower doses of insulin and does not increase the frequency of hypoglycemic episodes OBJECTIVE This study assesses the effects of insulin pump therapy on diabetes control and family life in children 1 - 6 years old with type 1 diabetes . RESEARCH DESIGN AND METHODS Twenty-six children with type 1 diabetes for > /=6 months were r and omly assigned to current therapy ( two or three shots per day using NPH insulin and rapid-acting analog ) or continuous subcutaneous insulin infusion ( CSII ) for 6 months . After 6 months , current therapy subjects were offered CSII .  Changes in HbA(1c ) , mean blood glucose ( MBG ) , hypoglycemia frequency , diabetes-related quality of life ( QOL ) , and parental adjustment were recorded . RESULTS Eleven subjects from each group completed the trial ( age 46.3 + /- 3.2 months [ means + /- SE ] ) . At baseline , there were no differences between groups in HbA(1c ) , MBG , age , sex , diabetes duration , or parental QOL . Mean HbA(1c ) , MBG , and parental QOL were similar between groups at 6 months . Mean HbA(1c ) and MBG did not change from baseline to 6 months in either group . The frequency of severe hypoglycemia , ketoacidosis , or hospitalization was similar between groups at any time period . Subjects on CSII had more fasting and predinner mild/moderate hypoglycemia at 1 and 6 months . Diabetes-related QOL improved in CSII fathers from baseline to 6 months . Psychological distress increased in current therapy mothers from baseline to 6 months . All subjects continued CSII after study completion . CONCLUSIONS CSII is safe and well tolerated in young children with diabetes and may have positive effects on QOL . CSII did not improve diabetes control when compared with injections , despite more mild/moderate hypoglycemia . The benefits and realistic expectations of CSII should be thoroughly examined before starting this therapy in very young children OBJECTIVE To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System ( CGMS ) . DESIGN Open r and omized crossover comparing 3(1/2 ) months of multiple daily injections ( MDI ) and continuous subcutaneous insulin infusion ( CSII ) . SETTING Tertiary care , university-affiliated medical center . Patients Twenty-three children and adolescents with type 1 diabetes mellitus . INTERVENTIONS The CGMS was applied for 72 hours after 1 month and at the end of each study arm . MAIN OUTCOME MEASURES Hemoglobin A(1c ) levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm . RESULTS The arms were similar for mean ( SD ) hemoglobin A(1c ) levels ( CSII , 8.0 % [ 0.8 % ] ; and MDI , 8.2 % [ 0.8 % ] ) and glucose levels . Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia ( P = .01 and .04 , respectively ) and for postpr and ial hypoglycemia and hyperglycemia ( P = .03 and .05 , respectively ) . The rate of hyperglycemia increased during CSII ( P = .03 ) , but 24-hour duration and area under the curve for hyperglycemia were similar . Compared with the first CGMS reading in each arm , the second had a longer mean duration of postpr and ial within-target glucose levels ( P = .04 ) , tendency for lower rate of diurnal hypoglycemic events ( P = .1 ) , shorter duration of nocturnal hypoglycemia ( P = .05 ) , and smaller 24-hour area under the curve for hypoglycemia ( P = .04 ) . CONCLUSIONS Intensive treatment with CSII seemed to be associated with slightly better prebreakfast , postpr and ial , and within-target glucose profiles than MDI , as well as a smaller area under the curve for hypoglycemia . Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia OBJECTIVE The efficacy of the insulin analogs now available for multiple daily injection ( MDI ) and continuous subcutaneous insulin infusion ( CSII ) therapy in type 1 diabetes has not yet been established in pediatric patients . Our principal aim in this short-term study was to compare the efficacy of CSII to MDI with glargine in lowering HbA(1c ) levels in children and adolescents with type 1 diabetes . RESEARCH DESIGN AND METHODS Thirty-two youth with type 1 diabetes ( age 8 - 21 years ) were r and omly assigned to receive either MDI treatment with once-daily glargine and premeal/snack insulin aspart or CSII with insulin aspart . Dose titration in both groups was based on home self-monitored blood glucose measurements and monthly HbA(1c ) . HbA(1c ) , total daily insulin dose ( TDD ) , self-monitored blood glucose readings , and adverse events were compared after 16 weeks of therapy . RESULTS While there was no significant change in the glargine group ( HbA(1c ) 8.2 % at baseline vs. 8.1 % at 16 weeks ) , youth r and omized to CSII had a sharp reduction in HbA(1c ) levels , from 8.1 to 7.2 % after 16 weeks of therapy ( P < 0.02 vs. baseline and < 0.05 vs. glargine group ) . TDD was unchanged in the glargine group , but significantly dropped with CSII ( 1.4 units/kg at baseline vs. 0.9 units/kg at 16 weeks , P < 0.01 ) . Both groups had similar basal doses and insulin-to-carbohydrate ratios . Fasting self-monitored blood glucose was similar in both groups , but lunch , dinner , and bedtime readings were significantly lower in the CSII group ( P < 0.01 ) . CONCLUSIONS Lower HbA(1c ) and premeal glucose levels were more achievable in this short-term study with CSII than with glargine-based MDI treatment . CSII is an efficacious treatment to improve metabolic control in youth with type 1 diabetes OBJECTIVE To examine the efficacy and safety of using continuous subcutaneous insulin infusion ( CSII ) therapy in a large group of patients 18 months to 18 yr from a single pediatric diabetes program . RESEARCH DESIGN AND METHODS All patients < or = 18 yr of age starting on CSII from 1 January 1997 to 31 March 2000 at the Yale Children 's Diabetes Program were included . Clinical data were collected prospect ively before and during pump treatment . HbA1c was the primary efficacy outcome and rates of diabetes-related adverse events were the primary safety measures . RESULTS One hundred and sixty-one children ranging in age from 18 months to 18 yr received CSII for an average of 32 + /- 9 months when data collection was closed on 31 October 2001 , including 26 preschoolers ( < 7 yr ) , 76 school-agers ( 7 - 11 yr ) and 59 adolescents ( 12 - 18 yr ) .  Mean HbA1c levels were 7.1 % in the preschoolers , 7.8 % in the school-agers and 8.1 % in the adolescents prior to the start of CSII . There was a significant and consistent reduction in mean HbA1c levels after 12 months of CSII ( to 6.5 % in preschoolers , 7.3 % in school-agers and 7.4 % in adolescents , p < 0.02 vs. prepump ) that was maintained at the most recent visit . Improved diabetes control was achieved with CSII without increasing daily insulin doses and in association with a decrease in the frequency of severe hypoglycemic events ( p < 0.05 vs. prepump , all three age groups combined ) . CONCLUSIONS CSII is an effective alternative to injection therapy in a large pediatric diabetes clinic setting . Even very young 
    Output:
    
Combined data from all trials showed that the CSII group compared with the MDI group experienced a significant reduction in the level of glycosylated hemoglobin .
In short-term insulin therapy , CSII compared with MDI is a more effective form of metabolic control and allows reducing the daily insulin requirement .
Yet , no conclusions have been made so far whether this effect holds in later years .