Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections in Adolescents with Type I Diabetes Mellitus: A Randomized Open Crossover Trial

Cohen, Daniela; Weintrob, Naomi; Benzaquen, Hadassa; Galatzer, Avinoam; Fayman, Gila; Phillip, Moshe

doi:10.1515/jpem.2003.16.7.1047

Cited by 47 publications

(53 citation statements)

References 1 publication

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“…37 No significant difference was reported in the change from baseline body mass index (BMI) standard deviation score (SDS) between the MDI and CSII intervention groups; however, scores decreased slightly more with CSII (mean between-group difference -0.12 units; 95% CI, -0.55 to 0.30; P =0.984). 36,37 No significant difference was found in general quality of life between CSII and MDI in this population (mean between-group difference, 2.3; 95% CI, -6.9 to 11.5; P = 0.95; low strength of evidence). Of studies that reported Diabetes Quality of Life-Youth scores, 1 good-quality study showed improvement favoring CSII, 36 while another study did not find a difference in diabetes quality of life between the 2 interventions.…”

Section: Assessments Of Study Quality and Strength Of Evidencementioning

confidence: 70%

“…36,37 No significant difference was found in general quality of life between CSII and MDI in this population (mean between-group difference, 2.3; 95% CI, -6.9 to 11.5; P = 0.95; low strength of evidence). Of studies that reported Diabetes Quality of Life-Youth scores, 1 good-quality study showed improvement favoring CSII, 36 while another study did not find a difference in diabetes quality of life between the 2 interventions. 35 When examining diabetes treatment-related quality of life, as assessed by Diabetes Treatment Satisfaction Questionnaire (DTSQ), a meta-analysis of 2 studies favored CSII over MDI (mean between-group difference, 5.7; 95% CI, 5.0-6.4; P < 0.001), although the variation in the effect due to heterogeneity was significant (low strength of evidence).…”

Section: Assessments Of Study Quality and Strength Of Evidencementioning

confidence: 70%

“…Similar results were seen in A1c among adolescents over 12 years of age, while less difference was seen among children 12 years of age and younger ( Figure 1). Also, no significant difference was observed between CSII and MDI in measures for daytime 29,31,36 and nocturnal hypoglycemia 35,36 (low strength of evidence), severe hypoglycemia 29 (low strength of evidence), frequency of hyperglycemia 37 (insufficient strength of evidence), and ratio of basal to bolus The mean between-group difference in fasting glucose over 6 months was -12.3 mg/dL (95% CI, -32.9 to 8.2; P = NS) favoring CSII in 1 study, 38 while 2 other studies reported no difference in fasting glucose between the intervention groups (low strength of evidence). 43,44 Additionally, the mean betweengroup difference in pre-prandial glucose over 6 months was -17.1 mg/dL (95% CI, -42.1 to 8.0; P = NS) favoring CSII in 1 study, 38 and in another study, pre-dinner glucose was lower with CSII (128 mg/dL) compared with MDI (148 mg/dL) at the end of 5 weeks (P = NS).…”

Section: Children and Adolescents With T1dmmentioning

confidence: 77%

“…[28][29][30][31][32][33][34][35][36][37] Participants generally had diabetes for 5 to 6 years prior to study entry, had poor glycemic control at study entry (mean A1c, 8% to 9%), and were treated in the intervention groups for an average of 52 weeks. The mean age of participants in the RCTs was 16.5 years (range, 4.4 to 18.9 years) and 11.4 years (range, 4.4 to 17.9 years) in the MDI and CSII groups, respectively, and 1 study did not report age of participants.…”

Section: Children and Adolescents With T1dmmentioning

confidence: 99%

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Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

Golden¹,

Sapir²

2012

JMCP

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, before training in internal medicine and endocrinology and metabolism at the Johns Hopkins Hospital. During her fellowship in endocrinology, she received a master of health science degree in clinical epidemiology from the Johns Hopkins University Bloomberg School of Public Health. Her primary research interest centers around identifying endocrine risk factors associated with the development of diabetes and cardiovascular disease through the incorporation of measures of hormonal function into the design of clinical trials of cardiovascular risk modification, observational studies of incident cardiovascular disease and diabetes, and studies evaluating diabetic complications. Her current research focuses on studying the neuroendocrine response to chronic psychological stress as a risk factor for diabetes and cardiovascular disease. Dr Supplement Policy Statement Standards for Supplements to the Journal of Managed Care PharmacySupplements to the Journal of Managed Care Pharmacy are intended to support medical education and research in areas of clinical practice, health care quality improvement, or efficient administration and delivery of health benefits. The following standards are applied to all JMCP supplements to ensure quality and assist readers in evaluating potential bias and determining alternate explanations for findings and results. 1. Disclose the principal sources of funding in a manner that permits easy recognition by the reader. 2. Disclose the existence of all potential conflicts of interest among supplement contributors, including financial or personal bias. 3. Describe all drugs by generic name unless the use of the brand name is necessary to reduce the opportunity for confusion among readers. 4. Identify any off-label (unapproved) use by drug name and specific off-label indication. 5. Strive to report subjects of current interest to managed care pharmacists and other managed care professionals. S15 References Target AudiencesThis CME activity is designed to meet the educational needs of physicians, pharmacists, nurses, and case managers involved in the management and care of patients with diabetes. Learning ObjectivesBased on the findings from the Agency for Healthcare Research and Quality' s (AHRQ) comparative effectiveness review of insulin delivery and glucose-monitoring modalities for diabetes, participants should be able to: 1. Compare the benefits of insulin delivery systems in improving clinical outcomes, glycemic control, hypoglycemia, and quality of life in diabetic patients receiving intensive insulin therapy 2. Evaluate the differential effect of glucose-monitoring approaches on the process measures and intermediate and clinical outcomes in diabetic patients receiving intensive insulin therapy 3. Apply the AHRQ findings to guide effective, patient-centered clinical decisions Funding There is no fee for this CME/CE activity. This learning activity was prepared and funded under contract HHSA290201000006G from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Hea...

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Section: Assessments Of Study Quality and Strength Of Evidencementioning

confidence: 70%

Section: Assessments Of Study Quality and Strength Of Evidencementioning

confidence: 70%

Section: Children and Adolescents With T1dmmentioning

confidence: 77%

Section: Children and Adolescents With T1dmmentioning

confidence: 99%

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Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

Golden¹,

Sapir²

2012

JMCP

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“…However, when CSII was compared to MDI in randomized crossover trials in children [42] or adolescents [43] and in randomized controlled trials of short duration in diabetic toddlers and young children [5, 13], there was no significant difference in HbA 1c values. One randomized controlled trial [24] reported a significantly lower HbA 1c in pediatric patients receiving CSII when compared to that of patients receiving MDI with glargine.…”

Section: Advantages Of Csiimentioning

confidence: 99%

The Use of Insulin Pump Therapy in the Pediatric Age Group

Shalitin

Phillip²

2008

Horm Res Paediatr

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Diabetic children and their caregivers face the never-ceasing challenge of maintaining blood glucose levels as close as possible to the normal range so as to prevent or delay long-term micro- and macrovascular complications, to minimize the risk of severe hypoglycemic episodes, and to improve quality of life. Continuous subcutaneous insulin infusion (CSII) therapy represents a treatment option that can aid in achieving these goals. Granted that insulin secretor responses to physiological stimuli are complex and difficult to duplicate, CSII is the most physiological method of insulin delivery currently available, simulating the pattern of insulin secretion with a continuous adjustable ‘basal’ delivery and superimposed mealtime ‘boluses’. CSII offers greater flexibility and more precise insulin delivery than do multiple daily injections, and thus can reduce the frequency of severe hypoglycemia. However, when CSII was compared to multiple daily injections in randomized crossover or controlled trials in children or adolescents, generally there was no significant difference in HbA_1c. This review briefly summarizes the current state of knowledge regarding the use of CSII in pediatric and adolescent patients with type 1 diabetes mellitus.

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

Misso

Egberts

Page³

et al. 2010

Cochrane Database of Systematic Reviews

294

155

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Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections in Adolescents with Type I Diabetes Mellitus: A Randomized Open Crossover Trial

Cited by 47 publications

References 1 publication

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

Methods for Insulin Delivery and Glucose Monitoring in Diabetes: Summary of a Comparative Effectiveness Review

The Use of Insulin Pump Therapy in the Pediatric Age Group

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

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