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Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes.

Abstract

BACKGROUND

Diabetes causes a rise in blood glucose above normal physiological levels causing damage to many systems including the cardiovascular and renal systems. Pregnancy causes a physiological reduction in insulin action; for those women who have pre-gestational diabetes, this results in an increasing insulin requirement. There are several methods of administering insulin. Conventionally, insulin has been administered subcutaneously, formally referred to as intensive conventional treatment, but now more usually referred to as multiple daily injections (MDI). An alternative insulin administration method is the continuous subcutaneous insulin infusion pump (CSII).

OBJECTIVES

To compare continuous subcutaneous insulin infusion with MDI of insulin for pregnant women with diabetes.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2006).

SELECTION CRITERIA

Randomised controlled trials comparing CSII with MDI for pregnant women with diabetes.

DATA COLLECTION AND ANALYSIS

Three authors independently assessed studies and extracted data.

MAIN RESULTS

Two studies (60 women with 61 pregnancies) were included. There was a significant increase in mean birthweight associated with CSII as opposed to MDI (weighted mean difference 220.56, 95% confidence interval (CI) -2.09 to 443.20; two trials, 61 participants). However, taking into consideration the lack of significant difference in rate of macrosomia (birthweight greater than 4000 g) (relative risk (RR) 3.20, 95% CI 0.14 to 72.62; two trials, 61 participants), this is not viewed by the authors as clinically significant. No significant differences were found in any other outcomes measured, which may reflect the small number of trials suitable for meta-analysis and the small number of participants in the included studies. No significant differences were found in perinatal mortality (RR 2.00, 95% CI 0.20 to 19.91), fetal anomaly (RR 1.07, 95% CI 0.07 to 15.54), maternal hypoglycaemia (RR 3.00, 95% CI 0.35 to 25.87) or maternal hyperglycaemia (RR 7.00, 95% CI 0.39 to 125.44).

AUTHORS' CONCLUSIONS

There is a dearth of robust evidence to support the use of one particular form of insulin administration over another for pregnant women with diabetes. The data are limited because of the small number of trials appropriate for meta-analysis, small study sample size and questionable generalisability of the trial population. Conclusions cannot be made from the data available and therefore a robust randomised trial is needed. The trial should be adequately powered to assess the efficacy of continuous subcutaneous insulin infusion versus multiple daily injections in terms of appropriate outcomes for women with diabetes.

Authors+Show Affiliations

Bradford Royal Infirmary Maternity Unit, Duckworth Lane, Bradford, UK, BD9 6RJ. diane.farrar@bradfordhospitals.nhs.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17636806

Citation

Farrar, D, et al. "Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections of Insulin for Pregnant Women With Diabetes." The Cochrane Database of Systematic Reviews, 2007, p. CD005542.
Farrar D, Tuffnell DJ, West J. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database Syst Rev. 2007.
Farrar, D., Tuffnell, D. J., & West, J. (2007). Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. The Cochrane Database of Systematic Reviews, (3), CD005542.
Farrar D, Tuffnell DJ, West J. Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections of Insulin for Pregnant Women With Diabetes. Cochrane Database Syst Rev. 2007 Jul 18;(3)CD005542. PubMed PMID: 17636806.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. AU - Farrar,D, AU - Tuffnell,D J, AU - West,J, Y1 - 2007/07/18/ PY - 2007/7/20/pubmed PY - 2007/10/19/medline PY - 2007/7/20/entrez SP - CD005542 EP - CD005542 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Diabetes causes a rise in blood glucose above normal physiological levels causing damage to many systems including the cardiovascular and renal systems. Pregnancy causes a physiological reduction in insulin action; for those women who have pre-gestational diabetes, this results in an increasing insulin requirement. There are several methods of administering insulin. Conventionally, insulin has been administered subcutaneously, formally referred to as intensive conventional treatment, but now more usually referred to as multiple daily injections (MDI). An alternative insulin administration method is the continuous subcutaneous insulin infusion pump (CSII). OBJECTIVES: To compare continuous subcutaneous insulin infusion with MDI of insulin for pregnant women with diabetes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2006). SELECTION CRITERIA: Randomised controlled trials comparing CSII with MDI for pregnant women with diabetes. DATA COLLECTION AND ANALYSIS: Three authors independently assessed studies and extracted data. MAIN RESULTS: Two studies (60 women with 61 pregnancies) were included. There was a significant increase in mean birthweight associated with CSII as opposed to MDI (weighted mean difference 220.56, 95% confidence interval (CI) -2.09 to 443.20; two trials, 61 participants). However, taking into consideration the lack of significant difference in rate of macrosomia (birthweight greater than 4000 g) (relative risk (RR) 3.20, 95% CI 0.14 to 72.62; two trials, 61 participants), this is not viewed by the authors as clinically significant. No significant differences were found in any other outcomes measured, which may reflect the small number of trials suitable for meta-analysis and the small number of participants in the included studies. No significant differences were found in perinatal mortality (RR 2.00, 95% CI 0.20 to 19.91), fetal anomaly (RR 1.07, 95% CI 0.07 to 15.54), maternal hypoglycaemia (RR 3.00, 95% CI 0.35 to 25.87) or maternal hyperglycaemia (RR 7.00, 95% CI 0.39 to 125.44). AUTHORS' CONCLUSIONS: There is a dearth of robust evidence to support the use of one particular form of insulin administration over another for pregnant women with diabetes. The data are limited because of the small number of trials appropriate for meta-analysis, small study sample size and questionable generalisability of the trial population. Conclusions cannot be made from the data available and therefore a robust randomised trial is needed. The trial should be adequately powered to assess the efficacy of continuous subcutaneous insulin infusion versus multiple daily injections in terms of appropriate outcomes for women with diabetes. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17636806/Continuous_subcutaneous_insulin_infusion_versus_multiple_daily_injections_of_insulin_for_pregnant_women_with_diabetes_ L2 - https://doi.org/10.1002/14651858.CD005542.pub2 DB - PRIME DP - Unbound Medicine ER -