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Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis.
Diabetologia 2008; 51(6):941-51D

Abstract

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.

Authors+Show Affiliations

Diabetes and Metabolism Outpatient Clinic, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. klaus.jeitler@klinikum-graz.atNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

18351320

Citation

Jeitler, K, et al. "Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Patients With Diabetes Mellitus: Systematic Review and Meta-analysis." Diabetologia, vol. 51, no. 6, 2008, pp. 941-51.
Jeitler K, Horvath K, Berghold A, et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia. 2008;51(6):941-51.
Jeitler, K., Horvath, K., Berghold, A., Gratzer, T. W., Neeser, K., Pieber, T. R., & Siebenhofer, A. (2008). Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia, 51(6), pp. 941-51. doi:10.1007/s00125-008-0974-3.
Jeitler K, et al. Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Patients With Diabetes Mellitus: Systematic Review and Meta-analysis. Diabetologia. 2008;51(6):941-51. PubMed PMID: 18351320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. AU - Jeitler,K, AU - Horvath,K, AU - Berghold,A, AU - Gratzer,T W, AU - Neeser,K, AU - Pieber,T R, AU - Siebenhofer,A, Y1 - 2008/03/20/ PY - 2007/09/12/received PY - 2008/02/05/accepted PY - 2008/3/21/pubmed PY - 2008/8/9/medline PY - 2008/3/21/entrez SP - 941 EP - 51 JF - Diabetologia JO - Diabetologia VL - 51 IS - 6 N2 - 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. SN - 0012-186X UR - https://www.unboundmedicine.com/medline/citation/18351320/Continuous_subcutaneous_insulin_infusion_versus_multiple_daily_insulin_injections_in_patients_with_diabetes_mellitus:_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1007/s00125-008-0974-3 DB - PRIME DP - Unbound Medicine ER -