Insulin Pump Therapy in Patients with Type 1 Diabetes Mellitus: Results of the Nationwide Quality Circle in Germany (ASD) 1999 - 2000

Hunger-Dathe, Wilgard; Braun, Avery; Müller, Ulrich A.; Schiel, Ralf; Femerling, M; Risse, Alexander

doi:10.1055/s-2003-44290

Cited by 28 publications

(36 citation statements)

References 11 publications

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“…We excluded 40 studies because of a low rate of severe hypoglycaemia on MDI, short duration of pump therapy, a design that was not an RCT or before/after study, because the protocol was unclear or there was apparent duplication of data found in another paper. Twenty-one studies were thus eligible for analysis of severe hypoglycemia [7,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] but, as one trial [21] reported results in two groups-a good and a poor control group, we included this as two data sets, resulting in 22 studies in total. Four additional studies [11,[41][42][43] were identified that compared glycaemic control during MDI using the long-acting insulin analogue glargine and CSII, but where rates of severe hypoglycaemia could not be estimated.…”

Section: Study Selectionmentioning

confidence: 99%

Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta‐analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion

2008

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Aims Continuous subcutaneous insulin infusion (CSII) is a recommended treatment for reducing severe hypoglycaemia in Type 1 diabetes, but the change in hypoglycaemia compared with multiple daily insulin injections (MDI) is unclear. We therefore conducted a meta-analysis comparing severe hypoglycaemia and glycaemic control during CSII and MDI.Methods Databases and literature (1996 -2006) were searched for randomized controlled trials (RCTs) and before/after studies of ≥ 6 months' duration CSII and with severe hypoglycaemia frequency > 10 episodes/100 patient years on MDI.Results In 22 studies (21 reports), severe hypoglycaemia during MDI was related to diabetes duration ( P = 0.038) and was greater in adults than children (100 vs. 36 events/100 patient years, P = 0.036). Severe hypoglycaemia was reduced during CSII compared with MDI, with a rate ratio of 2.89 (95% CI 1.45 to 5.76) for RCTs and 4.34 (2.87 to 6.56) for before/after studies [rate ratio 4.19 (2.86 to 6.13) for all studies]. The reduction was greatest in those with the highest initial severe hypoglycaemia rates on MDI ( P < 0.001). The mean difference in glycated haemoglobin (HbA 1c ) between treatments was less for RCTs [0.21% (0.13-0.30%)] than in before/after studies [0.72% (0.55-0.90%)] but strongly related to the initial HbA 1c on MDI ( P < 0.001). ConclusionsThe severe hypoglycaemia rate in Type 1 diabetes was markedly less during CSII than MDI, with the greatest reduction in those with most severe hypoglycaemia on MDI and those with the longest duration of diabetes. The biggest improvement in HbA 1c was in those with the highest HbA 1c on MDI.Diabet. Med. 25, 765-774 (2008)

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Section: Study Selectionmentioning

confidence: 99%

Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta‐analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion

2008

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“…167,168 Several studies described intensive training/ education of participants and their families. 101,140,144,146,147,152,[154][155][156][157][158][159][160][161][162][164][165][166][170][171][172][173][174] Some training programmes included the use of a dummy saline pump. 154,157,158,171 Initiation of pump therapy involved a period of admission to clinic or hospital in a few studies.…”

Section: Education and Support For Csiimentioning

confidence: 99%

“…101, [138][139][140][145][146][147]162,163,170 Two 138,139 did not report any hypoglycaemia before or after pumps use. Of the eight remaining studies, all reported a significant decrease after going on pumps.…”

Section: Hypoglycaemic Episodesmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Cummins

Royle²,

Snaith³

et al. 2010

Health Technol Assess

183

155

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of project...

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“…Age also plays an 17 Pump malfunction, tube leakage, use of outdated insulin, pump exposure to excessive heat or sunlight, catheter clogging or dislodgement, or infusion site infection-especially when the catheter and tubing set are left unchanged for more than 3 days-can result in interruption of insulin delivery. 18,19 It is important to note that DKA can also develop in type 2 diabetics depending on the patient's ability to secrete insulin (= insulin dependency) and nutritional status (i.e. starvation, see paragraph further below "starvation ketosis").…”

mentioning

confidence: 99%

Diagnosis and management of hyperglycemic emergencies

Chaithongdi¹,

Subauste²,

Koch³

et al. 2011

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this article is aimed at providing a practical up-to-date review of the precipitating factors, diagnosis, management and secondary prevention of hyperglycemic emergencies (diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHs) to assist critical care physicians and hospitalists caring for these patients. Limitations of various guidelines include implementation in settings with an infrastructure different from that specified in the guidelines of a respective country, state, region or community. Appropriate individualized acute management of these conditions typically results in satisfactory clinical outcomes and may decrease the mortality rate from up to 20% in type 2 diabetics with hyperglycemic hyperosmolar state vs less than 2% in patients with DKA. DKA may be the first manifestation of type 1 diabetes and can also occur in type 2 diabetics depending on the state of insulin sufficiency/secretion. For type 1 diabetics, the transition period from adolescence to adulthood is particularly critical to prevent repetitive hospital admissions. Hyperglycemic emergencies are usually preventable but do depend on patient compliance and adherence as well as medical infrastructure. Patients of all ages should be both appropriately educated and assured continuous access to health care to prevent recurrences of these conditions.

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Insulin Pump Therapy in Patients with Type 1 Diabetes Mellitus: Results of the Nationwide Quality Circle in Germany (ASD) 1999 - 2000

Abstract: The benefits of insulin pump therapy are improvement of HbA1c, reduction of hypoglycaemia, ketoacidosis and hospitalisation days as well as improved flexibility. It is possible to draw up a list of clinical criteria and service requirements, which are likely to reduce failures.

Cited by 28 publications

References 11 publications

Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta‐analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion

Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta‐analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Diagnosis and management of hyperglycemic emergencies

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