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Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion.
Diabet Med 2008; 25(7):765-74DM

Abstract

AIMS

Continuous subcutaneous insulin infusion (CSII) is a recommended treatment for reducing severe hypoglycaemia in Type 1 diabetes, but the change in hypoglycaemia compared with multiple daily insulin injections (MDI) is unclear. We therefore conducted a meta-analysis comparing severe hypoglycaemia and glycaemic control during CSII and MDI.

METHODS

Databases and literature (1996-2006) were searched for randomized controlled trials (RCTs) and before/after studies of > or = 6 months' duration CSII and with severe hypoglycaemia frequency > 10 episodes/100 patient years on MDI.

RESULTS

In 22 studies (21 reports), severe hypoglycaemia during MDI was related to diabetes duration (P = 0.038) and was greater in adults than children (100 vs. 36 events/100 patient years, P = 0.036). Severe hypoglycaemia was reduced during CSII compared with MDI, with a rate ratio of 2.89 (95% CI 1.45 to 5.76) for RCTs and 4.34 (2.87 to 6.56) for before/after studies [rate ratio 4.19 (2.86 to 6.13) for all studies]. The reduction was greatest in those with the highest initial severe hypoglycaemia rates on MDI (P < 0.001). The mean difference in glycated haemoglobin (HbA(1c)) between treatments was less for RCTs [0.21% (0.13-0.30%)] than in before/after studies [0.72% (0.55-0.90%)] but strongly related to the initial HbA(1c) on MDI (P < 0.001).

CONCLUSIONS

The severe hypoglycaemia rate in Type 1 diabetes was markedly less during CSII than MDI, with the greatest reduction in those with most severe hypoglycaemia on MDI and those with the longest duration of diabetes. The biggest improvement in HbA(1c) was in those with the highest HbA(1c) on MDI.

Authors+Show Affiliations

Metabolic Unit, King's College London School of Medicine, Guy's Hospital, London, UK. john.pickup@kcl.ac.ukNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

18644063

Citation

Pickup, J C., and A J. Sutton. "Severe Hypoglycaemia and Glycaemic Control in Type 1 Diabetes: Meta-analysis of Multiple Daily Insulin Injections Compared With Continuous Subcutaneous Insulin Infusion." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 25, no. 7, 2008, pp. 765-74.
Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med. 2008;25(7):765-74.
Pickup, J. C., & Sutton, A. J. (2008). Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabetic Medicine : a Journal of the British Diabetic Association, 25(7), pp. 765-74. doi:10.1111/j.1464-5491.2008.02486.x.
Pickup JC, Sutton AJ. Severe Hypoglycaemia and Glycaemic Control in Type 1 Diabetes: Meta-analysis of Multiple Daily Insulin Injections Compared With Continuous Subcutaneous Insulin Infusion. Diabet Med. 2008;25(7):765-74. PubMed PMID: 18644063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. AU - Pickup,J C, AU - Sutton,A J, PY - 2008/7/23/pubmed PY - 2008/8/21/medline PY - 2008/7/23/entrez SP - 765 EP - 74 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet. Med. VL - 25 IS - 7 N2 - AIMS: Continuous subcutaneous insulin infusion (CSII) is a recommended treatment for reducing severe hypoglycaemia in Type 1 diabetes, but the change in hypoglycaemia compared with multiple daily insulin injections (MDI) is unclear. We therefore conducted a meta-analysis comparing severe hypoglycaemia and glycaemic control during CSII and MDI. METHODS: Databases and literature (1996-2006) were searched for randomized controlled trials (RCTs) and before/after studies of > or = 6 months' duration CSII and with severe hypoglycaemia frequency > 10 episodes/100 patient years on MDI. RESULTS: In 22 studies (21 reports), severe hypoglycaemia during MDI was related to diabetes duration (P = 0.038) and was greater in adults than children (100 vs. 36 events/100 patient years, P = 0.036). Severe hypoglycaemia was reduced during CSII compared with MDI, with a rate ratio of 2.89 (95% CI 1.45 to 5.76) for RCTs and 4.34 (2.87 to 6.56) for before/after studies [rate ratio 4.19 (2.86 to 6.13) for all studies]. The reduction was greatest in those with the highest initial severe hypoglycaemia rates on MDI (P < 0.001). The mean difference in glycated haemoglobin (HbA(1c)) between treatments was less for RCTs [0.21% (0.13-0.30%)] than in before/after studies [0.72% (0.55-0.90%)] but strongly related to the initial HbA(1c) on MDI (P < 0.001). CONCLUSIONS: The severe hypoglycaemia rate in Type 1 diabetes was markedly less during CSII than MDI, with the greatest reduction in those with most severe hypoglycaemia on MDI and those with the longest duration of diabetes. The biggest improvement in HbA(1c) was in those with the highest HbA(1c) on MDI. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/18644063/Severe_hypoglycaemia_and_glycaemic_control_in_Type_1_diabetes:_meta_analysis_of_multiple_daily_insulin_injections_compared_with_continuous_subcutaneous_insulin_infusion_ L2 - https://doi.org/10.1111/j.1464-5491.2008.02486.x DB - PRIME DP - Unbound Medicine ER -