Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH‐based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5‐nations trial

Hoogma, Roel P.L.M.; Hammond, Peter J.; Gomis, Ramón; Kerr, David; Bruttomesso, Daniela; Bouter, K.P.; Wiefels, K; Calle, Hermenegildo de la; Schweitzer, Dave H.; Pfohl, Martin; Torlone, Elisabetta; Krinelke, Lars; Bolli, Geremia B.

doi:10.1111/j.1464-5491.2005.01738.x

Cited by 228 publications

(176 citation statements)

References 26 publications

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“…In seven [13,19,22,30,35,36,39] of these investigations, the difference was statistically significant. One study [20] did not find any difference between the treatment groups and another [16] showed insulin requirements to be higher under pump therapy, but without statistical significance.…”

Section: Total Insulin Requirementsmentioning

confidence: 86%

“…Adult patients with type 1 diabetes mellitus Of 14 studies reporting total insulin requirements at the end of treatment, 12 [13,19,22,24,28,30,[33][34][35][36][37]39] consistently found that the insulin doses were lower in CSII-treated patients. In seven [13,19,22,30,35,36,39] of these investigations, the difference was statistically significant.…”

Section: Total Insulin Requirementsmentioning

confidence: 99%

“…Three others [33,35,36] reported that no severe hypoglycaemia was observed. Information on the number of patients with severe hypoglycaemic episodes could be found in six studies [13,21,22,24,28,34] and four [32,[37][38][39] at least reported on the rates or the number of severe hypoglycaemic events in the treatment groups. The proportion of patients with severe hypoglycaemic episodes ranged from 0 to 0.13 in the CSII group and from 0 to 0.4 in the MDI group.…”

Section: Hypoglycaemiamentioning

confidence: 99%

“…Two other studies [30,37] presented results for overall hypoglycaemia only, but for the latter [37] the rate of mild/minor hypoglycaemic events could be calculated because exact numbers of severe events were available. Six studies [21,22,24,28,36,39] provided the event rates for mild/minor hypoglycaemia per patient per time period, which ranged from 0.9 to 3.1 weekly events per patient in the CSII groups and from 1.1 to 3.3 in the MDI groups (ranges include previously mentioned study [37]). The median rate per patient per week was 1.9 in the CSII groups and 1.7 in the MDI groups.…”

Section: Hypoglycaemiamentioning

confidence: 99%

“…In another study [38] only one serious adverse event was reported as causing a dropout in the CSII group. Another team [39] reported 15 serious adverse events in the MDI group compared with 20 events in the CSII group (including four events of ketoacidosis).…”

Section: Adverse Eventsmentioning

confidence: 99%

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Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

et al. 2008

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Aims We compared the effects of continuous subcutaneous insulin infusion (CSII) with those of multiple daily insulin (MDI) injections on glycaemic control, risk of hypoglycaemic episodes, insulin requirements and adverse events in type 1 and type 2 diabetes mellitus. Methods The electronic databases MEDLINE, EMBASE and CENTRAL were systematically searched for randomised controlled trials up to March 2007. A systematic review and meta-analysis were performed. Results Overall, 22 studies were included (17 on type 1 diabetes mellitus, two on type 2 diabetes mellitus, three on children). With regard to adults with type 1 diabetes mellitus, our meta-analysis found a between-treatment difference of −0.4% HbA 1c (six studies) in favour of CSII therapy. Available median rates of mild or overall hypoglycaemic events were comparable between the different interventions (1.9 [0.9-3.1] [CSII] vs 1.7 [1. 1-3.3] [MDI] events per patient per week). 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 HbA 1c . The incidence of mild hypoglycaemic events was comparable between the treatment groups. In adolescents with type 1 diabetes mellitus, glycated haemoglobin and insulin requirements were significantly lower in the CSII groups; no data were available on hypoglycaemic events. The only study performed in younger children did not provide enough data for conclusive inferences. No overall conclusions were possible for severe hypoglycaemia and adverse events for any of the different patient groups due to rareness of such events, different definitions and insufficient reporting. Conclusions/interpretation CSII therapy in adults and adolescents with type 1 diabetes mellitus resulted 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. Diabetologia (2008) 51:941-951

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