Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials

Abstract

Original ArticleContinuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trialsPań kowska E, B1azik M, Dziechciarz P, Szypowska A, Szajewska H. Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials. Pediatric Diabetes 2009: 10: 52-58.Objective: To investigate potential effects of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) on glycemic control in children with type 1 diabetes mellitus (T1DM). Study design: Meta-analysis and systematic review of randomized control studies (RCTs). The electronic databases MEDLINE, Cochrane Library, and EMBASE were searched through October 2007. Results: Six RCTs involving 165 participants with T1DM met our predefined inclusion criteria. 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. The pooled weighted mean difference (WMD) was 20.24% [95% confidence interval (95% CI) 20.41 to 20.07, p , 0.001] with a fixed model and remained significant in the random effect model. This effect was reached by slightly decreasing insulin requirement [three RCTs, n ¼ 74, WMD 20.22 IU/kg/d (95% CI 20.31 to 20.14, p , 0.001)]. No differences in the incidences of ketoacidosis and severe hypoglycemic events were found. Conclusions: 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. These results should be approached with caution because of the methodological limitations of the analyzed studies.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Type 2 Diabetes: A Meta-analysis

“…It should be considered that subgroup analysis failed to detect any relevant improvement of metabolic control with CSII in younger children, even if this result is controversial [27]. The reasons for the apparent lack of superiority in children are speculative; it can be hypothesized that young children are unable to perform accurate adjustments of prandial insulin doses, or that they are less likely to administer additional boluses in case of moderate hyperglycemia.…”

MANAGEMENT OF ENDOCRINE DISEASE: Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials

“…In our meta-analysis, we included only trials with a similar method of insulin administration in both control and experimental groups. Previous meta-analyses had already shown that CSII compared with MDI was a more effective form of metabolic control (20,21). Therefore, assessment of the efficacy of RT-CGM is not possible if the insulin delivery method is different in experimental and control groups.…”

“…Over 80% of patients included in our analysis were treated with CSII. Our previous meta-analysis demonstrated a statistical difference between CSII and MDI therapies (20). CSII therapy was associated with a significant reduction in HbA1c in comparison to MDI, without an increased risk of major hypoglycemia.…”

The poor children of the poor: Coping with diabetes control in a resource-poor setting

“…Several metaanalyses show a statistical difference in favour of pump therapy, but only amounting to a minimal improvement of 0.2 -0.3% in HbA1c values. [9][10][11][12] Similarly, continuous subcutaneous glucose sensing devices exist to improve blood glucose control, but again by a clinically unimportant amount. [13] It is gratifying that every one of our patients had access to a refrigerator.…”