Long‐term outcome of insulin pump therapy: reduction of hypoglycaemia and impact on glycaemic control

Quirós, Carmen; Giménez, Marga; Rios, Paola; Careaga, M; Roca, Daría; Vidal, Mercè; Conget, Ignacio

doi:10.1111/dme.13094

Cited by 39 publications

(21 citation statements)

References 16 publications

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“…Those with initial hypoglycaemia unawareness (Gold score ≥ 4) enjoyed an improvement in score on CSII (4.9 vs. 3.8, P = 0.01), with~38% regaining awareness. Quirόs et al [38] reported a 74% reduction in severe hypoglycaemia, sustained over the 5 years of the study, in a subgroup of people at a Spanish clinic who transferred to CSII because of recurrent severe hypoglycaemia on MDI.…”

Section: Hypoglycaemiamentioning

confidence: 91%

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Is insulin pump therapy effective in Type 1 diabetes?

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2018

Diabet. Med.

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There continues to be uncertainty about the effectiveness in Type 1 diabetes of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) vs. multiple daily insulin injections (MDI). This narrative review discusses the reasons for this uncertainty, summarizes the current evidence base for CSII and suggests some future research needs. There are difficulties in interpreting trials of CSII because effectiveness varies widely due to factors such as differing baseline control, suboptimal use of best CSII practices, and psychological factors, for example, high external locus of control, non-adherence and lack of motivation. Many summary meta-analyses are also misleading because of poor trial selection (e.g. short duration, obsolete pumps, low baseline rate of hypoglycaemia) and reliance on mean effect size for decision-making. Both MDI and CSII can achieve strict glycaemic control without hypoglycaemia in some people with Type 1 diabetes, especially those who are motivated and have undergone structured diabetes education, and with high levels of ongoing input from healthcare professionals. CSII is particularly effective in those people with Type 1 diabetes who have not achieved target HbA levels without disabling hypoglycaemia using best attempts with MDI, and here there can be valuable and substantial improvement. Insulin pumps are safe, effective and accepted when used in newly diagnosed diabetes, particularly in children, where MDI may not be practicable. Future research needs include more studies on mortality associated with insulin pumps where registry data have suggested lower rates vs. MDI; and psychological strategies to improve non-adherence and suboptimal glycaemic outcomes on CSII.

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Section: Hypoglycaemiamentioning

confidence: 91%

“…Quirόs et al . reported a 74% reduction in severe hypoglycaemia, sustained over the 5 years of the study, in a subgroup of people at a Spanish clinic who transferred to CSII because of recurrent severe hypoglycaemia on MDI.…”

Section: A Summary Of the Evidence For Csii Effectivenessmentioning

confidence: 99%

Is insulin pump therapy effective in Type 1 diabetes?

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2018

Diabet. Med.

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“…Quiros et al, 64 from Barcelona, followed 151 patients on pump therapy for 5 years. Overall, HbA 1c was reduced from a mean of 8.0% at baseline to 7.8% at 5 years.…”

Section: Overview Of Evidence Base For Pump Therapymentioning

confidence: 99%

“…There was a marked reduction in severe hypoglycaemia. 64 Rosenlund et al 65 from Denmark looked at the effects of 4 years of pump therapy on albuminuria compared with an unmatched group on MDI. On pump therapy, HbA 1c fell from 8.4% to 7.8%, maintained to 4 years.…”

Section: Overview Of Evidence Base For Pump Therapymentioning

confidence: 99%

A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial

Heller

White

Lee

et al. 2017

Health Technol Assess

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/107/01. The contractual start date was in June 2011. The draft report began editorial review in March 2016 and was accepted for publication in July 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by the NIH...

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“…Despite CSII being superior to MDI [7] in terms of efficiency and safety it does not provide long-lasting results in lowering the glycated hemoglobin (HbA 1c ) level [8]. While being a golden standard for treatment of type 1 diabetes, CSII cannot be of use for patients with type 2 diabetes because they seem not to benefit from this type of treatment [9].…”

Section: Insulin Pumpsmentioning

confidence: 99%