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Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis.
Ann Intern Med 2012; 157(5):336-47AIM

Abstract

BACKGROUND

Patients with diabetes mellitus need information about the effectiveness of innovations in insulin delivery and glucose monitoring.

PURPOSE

To review how intensive insulin therapy (multiple daily injections [MDI] vs. rapid-acting analogue-based continuous subcutaneous insulin infusion [CSII]) or method of monitoring (self-monitoring of blood glucose [SMBG] vs. real-time continuous glucose monitoring [rt-CGM]) affects outcomes in types 1 and 2 diabetes mellitus.

DATA SOURCES

MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through February 2012 without language restrictions.

STUDY SELECTION

33 randomized, controlled trials in children or adults that compared CSII with MDI (n=19), rt-CGM with SMBG (n=10), or sensor-augmented insulin pump use with MDI and SMBG (n=4).

DATA EXTRACTION

2 reviewers independently evaluated studies for eligibility and quality and serially abstracted data.

DATA SYNTHESIS

In randomized, controlled trials, MDI and CSII showed similar effects on hemoglobin A1c (HbA1c) levels and severe hypoglycemia in children or adults with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. In adults with type 1 diabetes mellitus, HbA1c levels decreased more with CSII than with MDI, but 1 study heavily influenced these results. Compared with SMBG, rt-CGM achieved a lower HbA1c level (between-group difference of change, 0.26% [95% CI, 0.33% to 0.19%]) without any difference in severe hypoglycemia. Sensor-augmented insulin pump use decreased HbA1c levels more than MDI and SMBG did in persons with type 1 diabetes mellitus (between-group difference of change, 0.68% [CI, 0.81% to 0.54%]). Little evidence was available on other outcomes.

LIMITATION

Many studies were small, of short duration, and limited to white persons with type 1 diabetes mellitus.

CONCLUSION

Continuous subcutaneous insulin infusion and MDI have similar effects on glycemic control and hypoglycemia, except CSII has a favorable effect on glycemic control in adults with type 1 diabetes mellitus. For glycemic control, rt-CGM is superior to SMBG and sensor-augmented insulin pumps are superior to MDI and SMBG without increasing the risk for hypoglycemia.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

Authors+Show Affiliations

The Johns Hopkins University, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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, U.S. Gov't, P.H.S.
Review
Systematic Review

Language

eng

PubMed ID

22777524

Citation

Yeh, Hsin-Chieh, et al. "Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus: a Systematic Review and Meta-analysis." Annals of Internal Medicine, vol. 157, no. 5, 2012, pp. 336-47.
Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med. 2012;157(5):336-47.
Yeh, H. C., Brown, T. T., Maruthur, N., Ranasinghe, P., Berger, Z., Suh, Y. D., ... Golden, S. H. (2012). Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Annals of Internal Medicine, 157(5), pp. 336-47.
Yeh HC, et al. Comparative Effectiveness and Safety of Methods of Insulin Delivery and Glucose Monitoring for Diabetes Mellitus: a Systematic Review and Meta-analysis. Ann Intern Med. 2012 Sep 4;157(5):336-47. PubMed PMID: 22777524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. AU - Yeh,Hsin-Chieh, AU - Brown,Todd T, AU - Maruthur,Nisa, AU - Ranasinghe,Padmini, AU - Berger,Zackary, AU - Suh,Yong D, AU - Wilson,Lisa M, AU - Haberl,Elisabeth B, AU - Brick,Jessica, AU - Bass,Eric B, AU - Golden,Sherita Hill, PY - 2012/7/11/entrez PY - 2012/7/11/pubmed PY - 2012/11/13/medline SP - 336 EP - 47 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 157 IS - 5 N2 - BACKGROUND: Patients with diabetes mellitus need information about the effectiveness of innovations in insulin delivery and glucose monitoring. PURPOSE: To review how intensive insulin therapy (multiple daily injections [MDI] vs. rapid-acting analogue-based continuous subcutaneous insulin infusion [CSII]) or method of monitoring (self-monitoring of blood glucose [SMBG] vs. real-time continuous glucose monitoring [rt-CGM]) affects outcomes in types 1 and 2 diabetes mellitus. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through February 2012 without language restrictions. STUDY SELECTION: 33 randomized, controlled trials in children or adults that compared CSII with MDI (n=19), rt-CGM with SMBG (n=10), or sensor-augmented insulin pump use with MDI and SMBG (n=4). DATA EXTRACTION: 2 reviewers independently evaluated studies for eligibility and quality and serially abstracted data. DATA SYNTHESIS: In randomized, controlled trials, MDI and CSII showed similar effects on hemoglobin A1c (HbA1c) levels and severe hypoglycemia in children or adults with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. In adults with type 1 diabetes mellitus, HbA1c levels decreased more with CSII than with MDI, but 1 study heavily influenced these results. Compared with SMBG, rt-CGM achieved a lower HbA1c level (between-group difference of change, 0.26% [95% CI, 0.33% to 0.19%]) without any difference in severe hypoglycemia. Sensor-augmented insulin pump use decreased HbA1c levels more than MDI and SMBG did in persons with type 1 diabetes mellitus (between-group difference of change, 0.68% [CI, 0.81% to 0.54%]). Little evidence was available on other outcomes. LIMITATION: Many studies were small, of short duration, and limited to white persons with type 1 diabetes mellitus. CONCLUSION: Continuous subcutaneous insulin infusion and MDI have similar effects on glycemic control and hypoglycemia, except CSII has a favorable effect on glycemic control in adults with type 1 diabetes mellitus. For glycemic control, rt-CGM is superior to SMBG and sensor-augmented insulin pumps are superior to MDI and SMBG without increasing the risk for hypoglycemia. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/22777524/Comparative_effectiveness_and_safety_of_methods_of_insulin_delivery_and_glucose_monitoring_for_diabetes_mellitus:_a_systematic_review_and_meta_analysis_ L2 - https://www.annals.org/aim/fullarticle/doi/10.7326/0003-4819-157-5-201209040-00508 DB - PRIME DP - Unbound Medicine ER -