Health-related quality of life in paediatric patients with Type 1 diabetes mellitus using insulin infusion systems. A systematic review and meta-analysis

Abstract

Background In 2017, more than 1.1 million children were living with type 1 diabetes mellitus (T1DM) globally. The goal in paediatric diabetes therapy is reaching optimal glycaemic control as early as possible in order to avoid complications and early mortality without compromising the quality of life (QoL) of children. Several different insulin regimens are available for T1DM patients to reach this goal. Aims This review set out to analyse whether continuous subcutaneous insulin infusion (CSII) regimens are superior to multiple daily injection (MDI) therapy in T1DM youth regarding QoL. Additionally, it assessed glycaemic control and adverse events as secondary outcomes and discussed potential future public health implications and justifications for using CSII as a first-line therapy in diabetic youth. Methods A systematic review and random effects meta-analysis was performed on studies investigating the association between QoL and diabetes treatment regimen. Differences in adverse event rates between groups were analysed using a Mann-Whitney U test. Lastly, differences in glycaemic control were assessed using a random effects meta-analysis. Results QoL and glycaemic control was significantly better in CSII subjects at baseline and follow-up. No significant differences in adverse events were found between study groups. No significant changes over time could be shown for either QoL or glycaemic control. Conclusion CSII proved to provide similar or slightly better outcomes in all analysed fields. This is consistent with previous research. However, to make credible recommendations, better-designed studies are needed to investigate the impact of CSII in children.

Effectiveness and equity of continuous subcutaneous insulin infusions in pediatric type 1 diabetes: A systematic review and meta-analysis of the literature

“…Our findings agree with those from recent meta-analyses of RCT [21][22][23][24][25][26]51], where children and adolescents using CSII vs MDI had lower mean HbA 1c , a tendency to fewer severe hypoglycemia episodes, and an improvement of quality of life. Our results did not substantially differ by patient's age.…”

“…HRQoL seemed to be slightly better in CYP on CSII, but the effect estimates were of small size and based on few studies, so they provided an insufficient level of evidence. A recently published meta-analysis reported results similar to ours, though based on a reduced number of studies [51]. We meta-analyzed only those studies with data on overall or diabetes-specific HRQoL at the end of the follow-up, measured with similar scales (PedsQL, KINDL-R and DQoL).…”

Health related quality of life in pediatric onset Type 1 diabetes mellitus in Kerala, India

“…The Global TEENS study had shown that the insulin regimen did not influence HRQoL 3 . But Rosner et al showed that CSII provided better HRQoL compared to multiple daily insulin (MDI) 18 …”

Smart Wearables for Cardiac Monitoring—Real-World Use beyond Atrial Fibrillation

“…Parents and children with chronic illnesses often show signs of increased stress, so wearability should not worsen this and should target improved quality of life. It is interesting to note that the use of insulin pumps reduces both patient and caregiver anxiety, in part because of decreased fear of hypoglycemia [ 102 ]. Validated wearables should aim to do the same for high-risk congenital and acquired heart disease, cardiomyopathy and inherited arrhythmia populations.…”