Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus

Misso, Marie; Egberts, Kristine J; Page, Matthew J.; O’Connor, Denise; Shaw, Jonathan E.

doi:10.1002/14651858.cd005103.pub2

Cited by 302 publications

(188 citation statements)

References 174 publications

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“…Day to day glucose variability is of greater concern to individuals and is poorly reflected in the HbA 1c measure. Indeed, 'real world' experience of new interventions such as structured education and insulin pump therapy suggest they have had a greater benefit on glucose variability than meaningful long-term changes to HbA 1c [38,39]. This is the first comprehensive study of the phenomenon of HbA 1c tracking and supports the need to optimise glycaemic control early in the natural history of type 1 diabetes.…”

Section: Discussionmentioning

confidence: 78%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

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Aims/hypothesis Our objectives were to explore whether the phenomenon of HbA 1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. Methods A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA 1c levels over time with random effects on general practices (primary care units) and individuals within practices. Results 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA 1c measurement (−7.0 [95% CI −8.0, −6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA 1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA 1c . Conclusions/interpretation In individuals with type 1 diabetes, glycaemic control measured by HbA 1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA 1c tracking level for the next 10 years.

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Section: Discussionmentioning

confidence: 78%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

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“…In our meta-analysis, we included only trials with a similar method of insulin administration in both control and experimental groups. Previous meta-analyses had already shown that CSII compared with MDI was a more effective form of metabolic control (20,21). Therefore, assessment of the efficacy of RT-CGM is not possible if the insulin delivery method is different in experimental and control groups.…”

Section: Discussionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials

Szypowska

Ramotowska

Dżygało

et al. 2012

European Journal of Endocrinology

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Objective: Real-time continuous glucose monitoring (RT-CGM) provides detailed information on glucose patterns and trends, thus allowing the patients to manage their diabetes more effectively. Design: The aim of this study was to explore the potential beneficial effects of the use of RT-CGM on diabetes management compared with self blood glucose measurement (SBGM) in patients with type 1 diabetes mellitus (T1DM), by means of a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: MEDLINE, EMBASE, and the Cochrane Library were searched through by two independent investigators for RCTs concerning the use of RT-CGM in patients with T1DM. Only studies with a similar insulin regimen in the experimental and control groups were included in the analysis. Results: Seven RCTs (nZ948) met the inclusion criteria. Combined data from all studies showed better HbA1c reduction in subjects using RT-CGM compared with those using SBGM (mean difference (MD) K0.25; 95% confidence interval (95% CI): from K0.34 to K0.17; P!0.001). Patients treated with insulin pump and RT-CGM had a lower HbA1c level compared with subjects managed with insulin pump and SBGM (four RCTs, nZ497; MD K0.26; 95% CI: from K0.43 to K0.10; PZ0.002). The benefits of applying RT-CGM were not associated with an increasing rate of major hypoglycemic episodes. The use of RT-CGM for over 60-70% of time was associated with a significant lowering of HbA1c. Conclusions: RT-CGM is more beneficial than SBGM in reducing HbA1c in patients with type 1 diabetes. Further studies are needed to evaluate the efficacy of this system in the pediatric population, especially in very young children.

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“…30,31 The improvement in hypoglycemia frequency does not appear to be at the expense of glycemic control. Several meta-analysis 29,32 and CSII retrospective audits 33,34 have shown that when compared to MDI, CSII improves metabolic control by an additional 0.3-0.7% reduction in HbA1c, with the greatest HbA1c reduction seen in those with poorest metabolic control at baseline. 29 …”

Section: Better Insulin Deliverymentioning

confidence: 99%

Technology to Reduce Hypoglycemia

Yeoh

Choudhary

2015

J Diabetes Sci Technol

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Hypoglycemia remains a major limiting factor toward the intensification of treatment for diabetes mellitus 1 and is a major cost to patients and to health care systems. 2 Hypoglycemia is often divided into mild or nonsevere hypoglycemia episodes (NSHE), where the person is able to selftreat, and severe hypoglycemia (SH), where external assistance is required. It is difficult to set a biochemical threshold for hypoglycemia, as the glucose threshold at which symptoms of hypoglycemia can be detected vary between individuals and even from day to day within the same person.3 The ADA workgroup on hypoglycemia offers some consensus guidelines, defining an alert value of ≤70 mg/dl, measured through self-monitored blood glucose (SMBG) or subcutaneous continuous glucose monitoring (CGM), as indicative of the potential for developing hypoglycemia. 4 All those treated with insulin secretagogues (sulphonylureas, glinides) and insulin therapy are at risk of hypoglycemia, and this risk is increased in the presence of endogenous insulin deficiency, longer duration of diabetes and longer duration of insulin therapy.5 Epidemiological data suggest that people with type 1 diabetes (T1D) with optimal glycemic control experience up to 2 mild episodes/week, with 20-30% experiencing episodes severe enough to require external help in any given year.6 A small proportion of these people, usually with impaired awareness of hypoglycemia, contribute to more than half of the incidence of SH, having recurrent disabling and sometimes life threatening events. 7CGM studies designed to study normative data suggest that while hypoglycemia is common in all insulin-treated people with diabetes, compared to subjects with type 2 diabetes (T2D), T1D subjects had twice as many hypoglycemic episodes per day, with more hours per day in the hypoglycemic range.8 However, although the incidence per patient of NSHE and SH is lower in T2D, due to the greater prevalence of T2D, the majority of episodes of SH occur in people with T2D. 9 In the US, rates of admissions for hypoglycemia have increased in recent years to 105 admissions per 100 000 person-years. 10 Antecedent hypoglycemia has been shown to blunt symptom and counter-regulatory hormonal responses to subsequent hypoglycemia.11 Over time, recurrent hypoglycemia eventually leads to a reduction in the ability to detect hypoglycemia and mount a hormonal response to it, known as impaired awareness of hypoglycemia (IAH) which can increase the risk of SH 6-fold. 12 In the T1D Exchange clinic registry, ≥ 1 SH events occurred in ~6% of over 9000 participants within 12 months, and was not associated with baseline glycated hemoglobin (HbA1c) levels. 13 Undoubtedly, SH has substantial clinical consequences on morbidity (both physical and psychological) and mortality. The more subtle effects of SH and hypoglycemia unawareness are often AbstractHypoglycemia is a major barrier toward achieving glycemic targets and is associated with significant morbidity (both psychological and physical) and mortality. This article re...

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Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus

Cited by 302 publications

References 174 publications

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

MANAGEMENT OF ENDOCRINE DISEASE: Beneficial effect of real-time continuous glucose monitoring system on glycemic control in type 1 diabetic patients: systematic review and meta-analysis of randomized trials

Technology to Reduce Hypoglycemia

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