Technology or Tradition? Comparing CSII and MDI in Indian Type 1 Diabetes Patients with Limited Resources

Background: Type 1 diabetes mellitus (T1DM) management requires intensive insulin therapy to maintain glycemic control. Basal-bolus injections (multiple daily injections, MDI) and continuous subcutaneous insulin infusion (CSII) via insulin pumps are commonly used regimens. In resource-limited settings, the choice of therapy is influenced by factors such as cost, accessibility, and effectiveness. Limited data exist comparing these modalities among Indian patients with T1DM. Aims: To compare the effectiveness of insulin pump therapy versus basal-bolus insulin injections in Indian patients with T1DM using continuous glucose monitoring system (CGMS) data. Methodology: Fifty-seven individuals with T1DM monitored using CGMS were included and divided into two groups: 31 on basal-bolus therapy (Group A) and 26 on insulin pump therapy (Group B). Mean ages were 18.9 ± 5.0 years (Group A) and 16.4 ± 5.1 years (Group B). Baseline data, including demographics, duration of diabetes, insulin dose, and HbA1c, were collected. Glycemic metrics from CGMS—time in range (TIR), time above range (TAR), and time below range (TBR)—were analyzed. Results: Baseline characteristics were similar between groups, with no significant differences in body mass index, diabetes duration, or initial HbA1c. The insulin pump group required significantly lower insulin doses (24.4 ± 7.9 units vs. 43.5 ± 15.8 units; P < 0.0001). Mean TIR was slightly higher in the MDI group (38.9% vs. 32.9%; P = 0.1806), although more patients in the pump group achieved target TIR >70% (7.7% vs. 0%). TAR was higher in the pump group (55.7% vs. 43.5%; P = 0.0522), while TBR was lower (11.3% vs. 20.0%; P = 0.0662). A greater proportion of the pump group achieved the target TBR <4% (46.2% vs. 19.3%; P = 0.03). Conclusions: In this resource-limited setting, insulin pump therapy was associated with lower insulin requirements and better TBR outcomes, although overall glycemic control (TIR and TAR) was comparable between CSII and MDI. Both therapies can be effective, and optimal outcomes depend on individualized care and consistent glucose monitoring.