The Efficacy And Utility Of Continuous Subcutaneous Insulin Infusion Pumps Compared To Multiple Daily Insulin Injections In The Management Of Paediatric Type One Diabetes Mellitus
(2013) The Efficacy And Utility Of Continuous Subcutaneous Insulin Infusion Pumps Compared To Multiple Daily Insulin Injections In The Management Of Paediatric Type One Diabetes Mellitus, no. 38.
Background: The importance of tight diabetic control has been well established, and the difficulties in maintaining near-normal glycaemic control due to bioavailability of insulin injection (MDII) therapy have been well studied. Continuous subcutaneous insulin infusion (CSII) by modern portable pump systems is an alternative to MDII-based therapies, but there is no recent robust systematic review within the paediatric population. Objective: To assess CSII and MDII in terms of glycaemic efficacy, effect on total insulin dose required to achieve this, and rate of severe hypoglycaemia. Methods: A systematic review of the literature was carried out, and relevant RCTs were obtained. RCTs were included if they compared the two technologies in terms of at least one of the outcomes defined above, were of at least 16 weeks' duration, and were in a paediatric population (0-18 years) Trials were critically appraised, and meta-analysis carried out. Separate analyses were carried out to determine the effect of study duration and patient age. Results: Ten RCTs fulfilled the inclusion criteria and were included for review. The meta-analysis showed a significant overall improvement in HbA1c when using CSII compared to MDII (change in HbA1c of -0.13%, (-0.28, -0.02, 95% CI), p=0.03, although this effect was most marked in the non-preschool population. Insulin requirements were also lowest in this group, although and this result was significant (-0.27U/kg/d, p<0.00001 (-0.34, -0.19, 95% CI). Adverse events were greatest in the pre-school population, but were lower in the CSII group compared to MDII for both cohorts. Conclusion: CSII is marginally more effective than MDII in terms of glycaemic control, but is associated with fewer side effects and requires less insulin. Not enough evidence to recommend it first-line or in those in the pre-school age group. It is not cost effective in younger patients or as a first-line therapy. A plain language summary is included as an appendix.