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Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis.
Endocrine. 2017 Jan; 55(1):77-84.E

Abstract

The relative efficacy of continuous subcutaneous insulin infusion and multiple daily injections in individuals with type 1 diabetes is unclear. We sought to synthesize the existing evidence about the effect of continuous subcutaneous insulin infusion on glycosylated hemoglobin, hypoglycemic events, and time spent in hypoglycemia compared to multiple daily injections. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus from January 2008 through November 2015 for randomized controlled trials that enrolled children or adults with type 1 diabetes. Trials identified in a previous systematic review and published prior to 2008 were also included. We included 25 randomized controlled trials at moderate risk of bias. Meta-analysis showed a significant reduction in glycosylated hemoglobin in patients treated with continuous subcutaneous insulin infusion compared to multiple daily injections (mean difference 0.37; 95 % confidence interval, 0.24-0.51). This effect was demonstrated in both children and adults. There was no significant difference in minor or severe hypoglycemic events. Continuous subcutaneous insulin infusion was associated with lower incidence of nocturnal hypoglycemia. There was no significant difference in the time spent in hypoglycemia. In children and adults with type 1 diabetes and compared to multiple daily injections, continuous subcutaneous insulin infusion is associated with a modest reduction in glycosylated hemoglobin. There was no difference in severe or minor hypoglycemia, but likely a lower incidence of nocturnal hypoglycemia with continuous subcutaneous insulin infusion.

Authors+Show Affiliations

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA.Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. murad.mohammad@mayo.edu. Division of Preventive, Occupational and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA. murad.mohammad@mayo.edu.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27477293

Citation

Benkhadra, Khalid, et al. "Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Individuals With Type 1 Diabetes: a Systematic Review and Meta-analysis." Endocrine, vol. 55, no. 1, 2017, pp. 77-84.
Benkhadra K, Alahdab F, Tamhane SU, et al. Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis. Endocrine. 2017;55(1):77-84.
Benkhadra, K., Alahdab, F., Tamhane, S. U., McCoy, R. G., Prokop, L. J., & Murad, M. H. (2017). Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis. Endocrine, 55(1), 77-84. https://doi.org/10.1007/s12020-016-1039-x
Benkhadra K, et al. Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Individuals With Type 1 Diabetes: a Systematic Review and Meta-analysis. Endocrine. 2017;55(1):77-84. PubMed PMID: 27477293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1 diabetes: a systematic review and meta-analysis. AU - Benkhadra,Khalid, AU - Alahdab,Fares, AU - Tamhane,Shrikant U, AU - McCoy,Rozalina G, AU - Prokop,Larry J, AU - Murad,Mohammad Hassan, Y1 - 2016/08/01/ PY - 2016/05/20/received PY - 2016/06/23/accepted PY - 2016/8/2/pubmed PY - 2017/7/14/medline PY - 2016/8/2/entrez KW - Continuous subcutaneous infusion KW - Diabetes KW - Diabetes mellitus type 1 KW - Insulin KW - Multiple daily injections KW - Systematic review SP - 77 EP - 84 JF - Endocrine JO - Endocrine VL - 55 IS - 1 N2 - The relative efficacy of continuous subcutaneous insulin infusion and multiple daily injections in individuals with type 1 diabetes is unclear. We sought to synthesize the existing evidence about the effect of continuous subcutaneous insulin infusion on glycosylated hemoglobin, hypoglycemic events, and time spent in hypoglycemia compared to multiple daily injections. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus from January 2008 through November 2015 for randomized controlled trials that enrolled children or adults with type 1 diabetes. Trials identified in a previous systematic review and published prior to 2008 were also included. We included 25 randomized controlled trials at moderate risk of bias. Meta-analysis showed a significant reduction in glycosylated hemoglobin in patients treated with continuous subcutaneous insulin infusion compared to multiple daily injections (mean difference 0.37; 95 % confidence interval, 0.24-0.51). This effect was demonstrated in both children and adults. There was no significant difference in minor or severe hypoglycemic events. Continuous subcutaneous insulin infusion was associated with lower incidence of nocturnal hypoglycemia. There was no significant difference in the time spent in hypoglycemia. In children and adults with type 1 diabetes and compared to multiple daily injections, continuous subcutaneous insulin infusion is associated with a modest reduction in glycosylated hemoglobin. There was no difference in severe or minor hypoglycemia, but likely a lower incidence of nocturnal hypoglycemia with continuous subcutaneous insulin infusion. SN - 1559-0100 UR - https://www.unboundmedicine.com/medline/citation/27477293/Continuous_subcutaneous_insulin_infusion_versus_multiple_daily_injections_in_individuals_with_type_1_diabetes:_a_systematic_review_and_meta_analysis_ L2 - https://dx.doi.org/10.1007/s12020-016-1039-x DB - PRIME DP - Unbound Medicine ER -