Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Type 2 Diabetes: A Meta-analysis

Abstract

Continuous subcutaneous insulin infusion (CSII) is considered an option for type 1 diabetic patients unsatisfactorily controlled with multiple daily injections (MDI). Short-acting analogs are superior to regular human insulin in CSII. This meta-analysis is aimed at assessing the advantages of short-acting analog-based CSII over MDI in type 1 diabetes. Randomized clinical trials (RCTs) comparing CSII (with analogs) and MDI for at least 12 weeks in type 1 diabetic patients were retrieved, assessing between-group differences in HbA1c and incidence of hypoglycemia. A total of 11 RCTs was included in the analysis. CSII was associated with a significant improvement of HbA1c in comparison with MDI (standardized difference in mean: -0.3 [-0.4;-0.1]%; P \ 0.001). No significant difference was observed in the rate of severe hypoglycemic episodes. The reduction of HbA1c with CSII was evident in trials enrolling patients with mean age greater than 10 years, but not in younger children. Available data justify the use of CSII for basal-bolus insulin therapy in type 1 diabetic patients unsatisfactorily controlled with MDI.

Accuracy of a New Patch Pump Based on a Microelectromechanical System (MEMS) Compared to Other Commercially Available Insulin Pumps

“…[1][2][3] Even though the latest meta-analyses comparing CSII with rapid insulin analogs showed only slight benefit in terms of HbA1c and hypoglycemic events, [4][5][6][7] an improvement in quality of life was observed in most studies. 8 Over the past decade, insulin pumps have received broader acceptance thanks to the development of functional insulin therapy (live insulin dose modification, bolus assistant), data recording, analysis and transfer capacity, and their ability to be coupled with continuous glucose monitoring.…”

Comparison of continuous subcutaneous insulin infusion and multiple daily insulin injections in Chinese patients with type 2 diabetes mellitus

“…In contrast, a meta-analysis of insulin replacement in patients with type 2 diabetes mellitus found that, compared with MDI, there was no difference in the daily insulin dose with CSII. 18 Similarly, a study carried out in Indian patients with type 2 diabetes mellitus did not show a significant difference in the total daily insulin dose between MDI and CSII methods. 19 In this present study, the results showed that the mean AE SD insulin dose per unit body weight for the MDI group (0.58 AE 0.18 IU/kg per day) was significantly higher than that for the CSII group (0.48 AE 0.17 IU/kg per day; P < 0.01), which suggests that compared with CSII therapy, the regulation of the basal dose with MDI therapy was not optimal.…”

Insulinpumpentherapie 2010

“…Die Frage einer frühen Insulintherapie -sei es eine ICT/MDI oder eine CSII -steht hinter der Anwendung der so genannten 7 oralen Antidiabetika zurück. Die Metaanalyse aus 4 RCTs aus den Jahren 2003 bis 2008 (525 Patienten) zeigte hinsichtlich des HbA1c-Wertes und der Rate von Hypoglykämien keinen Unterschied zwischen einer Behandlung mit CSII verglichen mit ICT/MDI [32]. Somit ist eine Pumpenindikation derzeit jedenfalls wissenschaftlich nicht begründet -aber in Einzelfällen indiziert.…”