Insulin Pump Therapy

Abstract

OBJECTIVE -To conduct a meta-analysis of the metabolic and psychosocial impact of continuous subcutaneous insulin infusion (CSII) therapy on adults, adolescents, and children.RESEARCH DESIGN AND METHODS -Studies were identified and data regarding study design, year of publication, sample size, patient's age, diabetes duration, and duration of CSII therapy were collected. Means and SDs for glycohemoglobin, blood glucose, insulin dosages, and body weight for CSII and comparison conditions were subjected to meta-analytic procedures. Data regarding pump complications and psychosocial functioning were reviewed descriptively.RESULTS -A total of 52 studies, consisting of 1,547 patients, were included in the metaanalysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993.CONCLUSIONS -CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis

“…It should also be noted that the heterogeneity is not so much caused by qualitatively different results, but by quantitative differences. From these limitations it is clear that the results obtained from this meta-analysis have to be interpreted cautiously even though they are consistent with previously published meta-analyses [7,8,47,48].…”

“…Since in many of the included trials the different definitions of hypoglycaemia were susceptible to bias and the endpoint detection was not blinded, results on hypoglycaemic events have to be viewed as inherently uncertain. Like Pickup et al [7], Colquitt et al [47] and Weissberg-Benchell et al [48], we also did not perform a meta-analysis on hypoglycaemic events, due to differences in definitions of hypoglycaemic episodes, the difference in study duration, the small numbers of patients with severe hypoglycaemic episodes and the often missing measures of variance.…”

Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: experience of the PedPump Study in 17 countries

“…The finding that HbA 1c concentrations were greater in adolescents than in younger age groups could reflect greater parental supervision of treatment in young children, as reported in other studies [26]. The finding that a longer duration of CSII use was associated with higher HbA 1c is at variance with a previous meta-analysis [27], which found that patients who received pump therapy for at least 1 year showed significant improvements in glycated haemoglobin, whereas no significant improvement was seen in patients treated for <1 year. Nevertheless the finding that many patients included in the previous survey increased their number of boluses between the previous survey and the present study indicates that constant re-education and motivation can achieve better long-term glycaemic control with CSII.…”

A run-to-run control strategy to adjust basal insulin infusion rates in type 1 diabetes

“…The deviation (4) where G is the corresponding blood glucose measurement, is the performance measure that is used as the controlled variable (ψ). The controlled variable vector (assuming four segments) is then (5) where k is the current day.…”

“…CSII pumps are becoming the preferred method to deliver insulin, as CSII therapy significantly improves glycemic control [4]. Pumps have the advantage that basal insulin delivery can be set at different rates for distinct segments of the day (e.g., the Paradigm ® pump, Medtronic MiniMed, Inc., Northridge, CA supports up to 48 segments).…”