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Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Of Insulin For Pregnant Women With Diabetes.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Of Insulin For Pregnant Women With Diabetes.

This article has been updated in " Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. " Cochrane Database Syst Rev. 2016;(6):CD005542. Diabetes causes a rise in blood glucose above normal physiological levels causing damage to many systems including the cardiovascular and renal systems. Pregnancy causes a physiological reduction in insulin action; for those women who have pre-gestational diabetes, this results in an increasing insulin requirement. There are several methods of administering insulin. Conventionally, insulin has been administered subcutaneously, formally referred to as intensive conventional treatment, but now more usually referred to as multiple daily injections (MDI). An alternative insulin administration method is the continuous subcutaneous insulin infusion pump (CSII).To compare continuous subcutaneous insulin infusion with MDI of insulin for pregnant women with diabetes.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2006).Randomised controlled trials comparing CSII with MDI for pregnant women with diabetes.Three authors independently assessed studies and extracted data.Two studies (60 women with 61 pregnancies) were included. There was a significant increase in mean birthweight associated with CSII as opposed to MDI (weighted mean difference 220.56, 95% confidence interval (CI) -2.09 to 443.20; two trials, 61 participants). However, taking into consideration the lack of significant difference in rate of macrosomia (birthweight greater than 4000 g) (relative risk (RR) 3.20, 95% CI 0.14 to 72.62; two trials, 61 participants), this is not viewed by the authors as clinically significant. No significant differences were found in any other outcomes mea Continue reading >>

Comparison Of Treatment With Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections With Bolus Calculator In Type 1 Diabetes | Endocrinologa Y Nutricin (english Edition)

Comparison Of Treatment With Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections With Bolus Calculator In Type 1 Diabetes | Endocrinologa Y Nutricin (english Edition)

Endocrinologa y Nutricin (English Edition) Index Medicus/MEDLINE, Excerpta Medica/EMBASE, SCOPUS, Science Citation Index Expanded, Journal Citation Reports/Science Edition, IBECS Source Normalized Impact per Paper (SNIP):0,383 Thomson Reuters, Journal Citation Reports, 2016 Endocrinol Nutr 2015;62:331-7 - DOI: 10.1016/j.endoen.2015.09.001 Comparison of treatment with continuous subcutaneous insulin infusion versus multiple daily insulin injections with bolus calculator in type 1 diabetes Comparacin del tratamiento con infusin subcutnea continua de insulina frente a la terapia con mltiples dosis de insulina con calculador de bolus en diabetes tipo 1 , M. Jos Goi-Iriarte, Marta Garca-Mouriz Servicio de Endocrinologa, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain Recibido 29 diciembre 2014, Aceptado 03 junio 2015 A study of the glycemic control, quality of life, and fear and perception of hypoglycemia by comparing continuous subcutaneous insulin infusion (CSII) group with multiple daily injections (MDI) with bolus calculator group. This is a retrospective cohort study with following up during the first 12 months that CSII group (n=30) begins the use of bolus wizard and the MDI-calculator (n=30) group begins the use of the bolus calculator (Accu-Chek Aviva Expert). Primary outcome: HbA1c (3, 6 and 12 months). Questionnaires used: EsDQOL (quality of life), FH-15 (fear of hypoglycemia), and Clarke (perception of hypoglycemia). Statistical analysis: Student's t and nonparametric tests. The average reduction in HbA1c during the study was significantly higher in CSII group (0.560.84%) compared with the MDI group (0.0970.94%), p=0.028. The average basal insulin dose was significantly higher in the MDI group (at baseline, 6 and 12 months). No significant differences Continue reading >>

A Cost-effectiveness Analysis Of Continuous Subcutaneous Insulin Injection Versus Multiple Daily Injections In Type 1 Diabetes Patients: A Third-party Us Payer Perspective

A Cost-effectiveness Analysis Of Continuous Subcutaneous Insulin Injection Versus Multiple Daily Injections In Type 1 Diabetes Patients: A Third-party Us Payer Perspective

Volume 12, Issue 5 , JulyAugust 2009, Pages 674-686 A Cost-Effectiveness Analysis of Continuous Subcutaneous Insulin Injection versus Multiple Daily Injections in Type 1 Diabetes Patients: A Third-Party US Payer Perspective To estimate the long-term cost-effectiveness of using continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) of insulin in adult and child/young adult type 1 diabetes mellitus (T1DM) patients from a third-party payer perspective in the United States. A previously validated health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI using published clinical and cost data. The primary input variable was change in HbA1c, and was assumed to be an improvement of 0.9% to 1.2% for CSII compared with MDI for child/young adult and adults, respectively. A series of Markov constructs simulated the progression of diabetes-related complications. CSII was associated with an improvement in quality-adjusted life-years (QALYs) gained of 1.061 versus MDI for adults and 0.799 versus MDI for children/young adults. ICERs were $16,992 and $27,195 per QALY gained for CSII versus MDI in adults and children/young adults, respectively. Improved glycemic control from CSII led to a lower incidence of diabetes complications, with the most significant reduction in proliferative diabetic retinopathy (PDR), end stage renal disease (ESRD), and peripheral vascular disease (PVD). The number needed to treat (NNT) for PDR was nine patients, suggesting that only nine patients need to be treated with CSII to avoid one case of PDR. The NNT for ESRD and PVD was 19 and 41, respectively. Setting the willingness to pay at $50,000/QALY, the analysis demonstrated that CSII is a cost-effective option Continue reading >>

Efficacy Of Continuous Subcutaneous Insulin Infusion Versus Basal-bolus Multiple Daily Injections Regimen In Type 2 Diabetes

Efficacy Of Continuous Subcutaneous Insulin Infusion Versus Basal-bolus Multiple Daily Injections Regimen In Type 2 Diabetes

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Efficacy of Continuous Subcutaneous Insulin Infusion Versus Basal-bolus Multiple Daily Injections Regimen in Type 2 Diabetes The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT00942318 Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information A lot of insulin-treated type 2 diabetic patients do not reach adequate glycemic control despite intensive basal-bolus insulin regimen. In such cases, continuous subcutaneous insulin infusion (CSII), using an external pump, could be a solution to improve diabetes control. The aim of this study is to compare, over a one-year period, the efficacy of CSII (with aspart insulin) and basal-bolus multiple daily injections (MDI) treatment (with detemir x 2/d and aspart before meals) in type 2 diabetic patients, already treated by basal-bolus regimen for at least 6 months, who didn't reach adequate target for glycemic at baseline (HbA1c>7 -10%). Drug: Detemir insulin, Aspart insulin, Metformin Visit 1: patient information and eligibility criteria assessment Visit 2: Inform consent signature and randomisation (group CSII or MDI). Patients randomised in the CSII group are instructed to use pump between V2 and V3. Visit 3: 5-day's hospitalisation. Start of CSII or MDI treatments. Stop of all oral diabetic medications except for metformin, which is followed up until the end of the study. Teaching program on Continue reading >>

Continuous Subcutaneous Insulin Infusion Vs. Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion Vs. Multiple Daily Injections

Continuous subcutaneous insulin infusion vs. multiple daily injections Intensive insulin therapy should be proposed for most type 1 diabetic patients. It can be achieved by a continuous subcutaneous insulin infusion (CSII) or by multiple daily injections (MDI). Debate remains regarding the optimal delivery of such therapy. To compare the efficacy of glycemic control, hypoglycemia frequency, dose of insulin and weight in the type 1 diabetic patients, after switching from MDI to CSII. In this retrospective study we analyzed HbA1c, profiles of blood glucose, weight, dose of insulin and hypoglycemia, 6 months before and 6 months after the initiation of CSII, in 18 patients with type 1 diabetes mellitus. Blood glucose control is considerably improved during CSII, as measured by HbA1c and mean blood glucose concentrations. Fasting blood glucose, postprandial glucose and also of glycemic variability were significantly lower. The total insulin doses during the CSII period were significantly lower. There was a small non significant increase in weight during CSII. There was a significant decrease in a number of mild hypoglycemic events, a small non significant decrease of asymptomatic hypoglycemia and a small non significant increase of nocturnal hypoglycemia. CSII provides significant improvement of blood glucose control with lower risk for hypoglycemia. Type 1 diabetes mellitusIntensive insulin therapy (IIT)Continuous subcutaneous insulin infusion (CSII)Multiple daily injections (MDI)Insulin analoguesBlood glucose controlHypoglycemia This is a preview of subscription content, log in to check access The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-d Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Of Insulin For Pregnant Women With Diabetes.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Of Insulin For Pregnant Women With Diabetes.

Cochrane Database Syst Rev. 2016 Jun 7;(6):CD005542. doi: 10.1002/14651858.CD005542.pub3. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Maternal and Child Health, Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK, BD9 6RJ. Diabetes results in a rise in blood glucose above normal physiological levels; if untreated this may cause damage to many systems including the cardiovascular and renal systems. Pregnancy increases resistance to insulin action; for those women who have pre-gestational diabetes, this results in an increasing insulin requirement. There are several methods of administering insulin. Conventionally, insulin has been administered subcutaneously, formally referred to as intensive conventional treatment, but now more usually referred to as multiple daily injections (MDI). An alternative method of insulin administration is the continuous subcutaneous insulin infusion pump (CSII). To compare CSII with MDI of insulin for pregnant women with pre-existing and gestational diabetes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2016) and reference lists of retrieved studies. Randomised trials comparing CSII with MDI for pregnant women with diabetes. Three review authors independently assessed studies and two review authors extracted data. Disagreements were resolved through discussion with the third author. We assessed the quality of the evidence using the GRADE approach. We included five single-centre trials (undertaken in Italy) with 153 women and 154 pregnancies in this review.There were no clear differences in the primary outcomes reported between CSII and MDI in the included trials: caesarean section (risk Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections: Theimpact Of Baseline A1c.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections: Theimpact Of Baseline A1c.

1. Diabetes Care. 2004 Nov;27(11):2590-6. Continuous subcutaneous insulin infusion versus multiple daily injections: theimpact of baseline A1c. Retnakaran R(1), Hochman J, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V,Zinman B. (1)Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada. Comment in Diabetes Care. 2005 Jul;28(7):1835-6. Diabetes Care. 2005 Mar;28(3):763; author reply 763-4. OBJECTIVE: Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the meal insulin of choice in both multiple daily insulin injection(MDII) therapy and continuous subcutaneous insulin infusion (CSII) for type 1diabetes. Thus, a comparison of efficacy between CSII and MDII should beundertaken only in studies that used rapid-acting analogs for both intensiveregimens.RESEARCH DESIGN AND METHODS: We performed a pooled analysis of the randomizedcontrolled trials that compared CSII and optimized MDII therapy usingrapid-acting analogs in adults with type 1 diabetes.RESULTS: The three studies that met inclusion criteria provided data on 139patients, representing 596 patient-months for CSII and 529 patient-months forMDII. Mean age was 38.5 years, with duration of diabetes of 18.0 years. Thestudies differed significantly in mean baseline A1c (7.95, 8.20, and 9.27%). The pooled estimate of treatment effect comparing the percentage reduction in A1c by CSII with that by MDII (CSII - MDII) was 0.35% (95% CI -0.10 to 0.80, P = 0.08)using a random effect to account for heterogeneity between studies. Importantly, the interaction between baseline A1c and treatment modality emerged as anindependent predictor of treatment effect (CSII - MDII) (P = 0.002). The relativebenefit of CSII over MDII was found to increase with higher baseline A1c. A modelderived fr Continue reading >>

Insulin Pumps Vs. Multiple Daily Injections (mdi): Which Is Better?

Insulin Pumps Vs. Multiple Daily Injections (mdi): Which Is Better?

Can insulin pumps reduce glycemic variability in type 1 diabetes?… A new cross-sectional observational cohort study looked at continuous subcutaneous insulin infusion (CSII), aka insulin pump, versus multiple daily injections (MDI) to determine which insulin delivery system resulted in less blood glucose variability in type 1 pediatric diabetes patients. Large variations in blood glucose have been implicated in causing cardiovascular complications which can lead to a number of comorbidities and mortality in diabetics. This recent study was performed in 48 pediatric type 1 diabetes patients, 22 of whom used an insulin pump while the others used MDI. The patients were followed for 3 days using continuous blood glucose monitoring; blood glucose variability was also assessed in 2 consecutive 24 hour periods by a surrogate marker, F2-isoprostanes and/or urinary prostaglandin F2 excretion. Results showed that standard deviation of mean glucose concentration (p<0.05) and insulin requirements, HDL-cholesterol, the mean of glycemic excursions (p<0.01) were statistically lower in the insulin pump group. While the study did not specifically look at the impact of insulin pump use vs. MDI on cardiovascular complications, one could assume that limiting glucose variations would have a positive impact on the cardiovascular system. The study was small and the MDI groups were even smaller. Each MDI group had somewhere between 4 – 9 patients who were assigned certain insulins whether that be normal, fast acting, basal and/or a combo of thereof. Further research and longitudinal studies would be of benefit to better assess association of CSII therapy versus MDI therapy and their impact on cardiovascular, co-morbidity, and mortality outcomes. Practice Pearls: Large variations in plasma Continue reading >>

Estimated Hba1c Similar With Continuous Subcutaneous Insulin Infusion, Multiple Daily Injections

Estimated Hba1c Similar With Continuous Subcutaneous Insulin Infusion, Multiple Daily Injections

Estimated HbA1c similar with continuous subcutaneous insulin infusion, multiple daily injections NEW ORLEANS Subcutaneous insulin infusion and multiple daily injections using a continuous glucose monitor both yielded similar estimated HbA1c levels, according to data presented at the American Diabetes Association Scientific Sessions. We were able to identify a group of continuous glucose monitor (CGM) users and compare their CGM data with age and method of delivery, David A Price, MD, of Dexcom Inc., said during a presentation. These data come from the [Type 1 Diabetes] Exchange and it shows that in 2015 roughly 16% of people in the [Type 1 Diabetes Exchange] registry were using CGM. Price and colleagues evaluated data on 67 million records of glucose values collected over a 6-month period from 1,587 CGM users in the Dexcom SHARE system (multiple daily injection, n = 648; continuous subcutaneous insulin infusion, n = 939). For each therapy method, estimated HbA1c values over the CGM range of 40 to 400 mg/dL were evaluated and compared across age groups. Overall, estimated HbA1c was similar between the two CGM therapies (multiple daily injection, 7.36% vs. continuous subcutaneous insulin infusion, 7.44%). Multiple daily injection was associated with a slightly lower standard deviation of glucose (60 mg/dL) compared with continuous subcutaneous insulin infusion (63 mg/dL). As users age increased, the estimated HbA1c and variation of glucose decreased with minimal differences between the therapies across age groups; age 2 to 6 years (multiple daily injection, 8.3% vs. continuous subcutaneous insulin infusion, 8.2%), age 7 to 12 years (7.9% vs. 8.1%) and age 13 to 18 years (7.5% vs. 7.8%). In CGM users, across age groups, there were no differences observed in mean glucose, Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections In Pregnant Women With Type 1 Diabetes Mellitus A Systematic Review And Meta-analysis Of Randomised Controlled Trials And Observational Studies

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections In Pregnant Women With Type 1 Diabetes Mellitus A Systematic Review And Meta-analysis Of Randomised Controlled Trials And Observational Studies

P Rys, Clinical Analysis Dept., HTA Consulting, Krakow, Poland A Ludwig-Somczyska, Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakw, 31-034, Poland K Cyganek, Department of Metabolic Diseases, Jagiellonian University, Krakow, Poland M Malecki, Department of Metabolic Disease, Jagiellonian University, Medical College, Krakow, Poland Correspondence: Przemyslaw Rys, Email: p.rys{at}hta.pl BACKGROUND: Randomised controlled trials (RCTs) have shown an advantage of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) in the general type 1 diabetes mellitus (T1DM) population. RCT data on T1DM management in pregnancy remain limited. OBJECTIVE: We performed a systematic review of both RCTs and non-RCTs evaluating CSII versus MDI in T1DM-complicated pregnancy. STUDY DESIGN: Electronic databases were searched for studies comparing CSII with MDI in T1DM-complicated pregnancy. METHODS: A meta-analysis provided point estimates with 95% confidence intervals (CI). Continuous outcomes were reported as weighted mean differences (WMD) or standardized mean differences (SMD), and dichotomous data as relative risk (RR). RESULTS: The search identified 47 studies, including 43 non-RCTs, reporting on 7824 pregnancies. The meta-analysis showed a lower HbA1c level with CSII versus MDI in the first trimester (WMD -0.45%; 95%CI -0.62, -0.27). This difference decreased in subsequent trimesters. Compared to MDI, therapy with CSII resulted in higher gestational weight gain (GWG) (WMD 1.02 kg; 95%CI 0.41, 1.62), and lower daily insulin dose requirements in the first (SMD -0.46; 95%CI -0.68, -0.24) and subsequent trimesters. Moreover, infants from the CSII group were more likely to be large-for-gestational-age (LGA) (RR 1.16; 95%CI 1.07 Continue reading >>

Csii Vs Mdi: The Evidence

Csii Vs Mdi: The Evidence

Insulin regimens are traditionally known as conventional, with two injections of mixed insulin, or intensive, in which the basal [background] and bolus [meal] insulin doses are given separately. Intensive insulin therapy has been shown to reduce risk of complications. It can be delivered as multiple daily dose insulin injections (MDI) including long acting basal insulin with boluses of rapid acting insulin given pre-meal, or using continuous subcutaneous insulin infusion [CSII] via an insulin pump. CSII delivers the basal component of the insulin regime via a slow infusion, and the patient can deliver boluses as and when required in addition to this. While both CSII and MDI are effective methods of intensive insulin therapy, they each have advantages and disadvantages. This review evaluates the evidence for both these regimens, highlighting the limitations of the evidence as it currently stands. In MDI, we separate out the basal and bolus components of insulin delivery. Basal insulin, delivered using long acting insulin [NPH, Determir, Glargine, Degludec] provides background insulin and ideally the dose is titrated to keep blood glucose stable if no carbohydrate is consumed. Fast acting insulin [Soluble insulin, Lispro, Aspart, Glulisine] is given pre-meal to cover the carbohydrate content of the meal and correct any readings that may be out of range. The DCCT study from the late 1980s showed that MDI provides tighter glucose control than conventional insulin given with twice daily mixed insulin, with a significant reduction in risk of complications of diabetes [1] . In this study, there was however a penalty to pay in the form of three-fold higher rates of severe hypoglycaemia requiring third party assistance. However, when MDI is used after structured education in fl Continue reading >>

Effectiveness Of Multiple Daily Injections Or Continuous Subcutaneous Insulin Infusion For Children With Type 1 Diabetes Mellitus In Clinical Practice

Effectiveness Of Multiple Daily Injections Or Continuous Subcutaneous Insulin Infusion For Children With Type 1 Diabetes Mellitus In Clinical Practice

Effectiveness of Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion for Children with Type 1 Diabetes Mellitus in Clinical Practice 1Beijing Childrens Hospital Affiliated with Capital Medical University, 56 South Lishi Road, Xicheng District, Beijing 100045, China 2Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101101, China Received 10 March 2014; Revised 19 July 2014; Accepted 28 July 2014; Published 14 August 2014 Copyright 2014 Chun-xiu Gong et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims. To determine whether multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) contributes to better glucose control in children with different type 1 diabetes duration. Methods. Subjects were grouped according to early ( 1 year after disease onset; 1A) or late (13 years after onset; 2A) MDIs/CSII treatment initiation. Corresponding control groups (1B, 2B) received insulin injections twice daily. Results. HbA1c levels were consistently lower in group 1A than in group 1B (6 months (T2): 7.37% versus 8.21%; 12 months (T3): 7.61% versus 8.41%; 24/36 months (T4/T5): 7.61% versus 8.72%; all ), but were lower in group 2A than in group 2B only at T2 (8.36% versus 9.19%; ). Levels were lower in group 1A than in group 2A when disease duration was matched (7.61% versus 8.49%; ). Logistic regression revealed no correlation between HbA1c level and MDIs/CSII therapy. HbA1c levels were only negatively related to insulin dosage. Conclusions. Blood glucose control was better in patients receiving MDIs/CSII than in those receiving conventional treatment. Early Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

The impact of baseline A1c Abstract OBJECTIVE—Rapid-acting insulin analogs (insulin lispro and insulin aspart) have emerged as the meal insulin of choice in both multiple daily insulin injection (MDII) therapy and continuous subcutaneous insulin infusion (CSII) for type 1 diabetes. Thus, a comparison of efficacy between CSII and MDII should be undertaken only in studies that used rapid-acting analogs for both intensive regimens. RESEARCH DESIGN AND METHODS—We performed a pooled analysis of the randomized controlled trials that compared CSII and optimized MDII therapy using rapid-acting analogs in adults with type 1 diabetes. RESULTS—The three studies that met inclusion criteria provided data on 139 patients, representing 596 patient-months for CSII and 529 patient-months for MDII. Mean age was 38.5 years, with duration of diabetes of 18.0 years. The studies differed significantly in mean baseline A1c (7.95, 8.20, and 9.27%). The pooled estimate of treatment effect comparing the percentage reduction in A1c by CSII with that by MDII (CSII − MDII) was 0.35% (95% CI −0.10 to 0.80, P = 0.08) using a random effect to account for heterogeneity between studies. Importantly, the interaction between baseline A1c and treatment modality emerged as an independent predictor of treatment effect (CSII − MDII) (P = 0.002). The relative benefit of CSII over MDII was found to increase with higher baseline A1c. A model derived from these data predicts that in a patient with a baseline A1c of 10%, CSII would reduce the A1c by an additional 0.65% compared with MDII. Conversely, there would be no A1c benefit of CSII compared with MDII if baseline A1c were 6.5%. There was no significant difference between CSII and MDII in the rate of hypoglycemic events. CONCLUSIONS—When using ra Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections In Individuals With Type 1 Diabetes: A Systematic Review And Meta-analysis

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections In Individuals With Type 1 Diabetes: A Systematic Review And Meta-analysis

N2 - The relative efficacy of continuous subcutaneous insulin infusion and multiple daily injections in individuals with type 1 diabetes is unclear. We sought to synthesize the existing evidence about the effect of continuous subcutaneous insulin infusion on glycosylated hemoglobin, hypoglycemic events, and time spent in hypoglycemia compared to multiple daily injections. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus from January 2008 through November 2015 for randomized controlled trials that enrolled children or adults with type 1 diabetes. Trials identified in a previous systematic review and published prior to 2008 were also included. We included 25 randomized controlled trials at moderate risk of bias. Meta-analysis showed a significant reduction in glycosylated hemoglobin in patients treated with continuous subcutaneous insulin infusion compared to multiple daily injections (mean difference 0.37; 95 % confidence interval, 0.240.51). This effect was demonstrated in both children and adults. There was no significant difference in minor or severe hypoglycemic events. Continuous subcutaneous insulin infusion was associated with lower incidence of nocturnal hypoglycemia. There was no significant difference in the time spent in hypoglycemia. In children and adults with type 1 diabetes and compared to multiple daily injections, continuous subcutaneous insulin infusion is associated with a modest reduction in glycosylated hemoglobin. There was no difference in severe or minor hypoglycemia, but likely a lower incidence of nocturnal hypoglycemia with continuous subcutaneous insulin infusion. AB - The relative efficacy of continuous subcutaneous insulin infusion and multiple daily injections in ind Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous subcutaneous insulin infusion versus multiple daily injections 1Diabetes Centre, 2nd Propaedeutic Department of Internal Medicine, Aristotle University, Hippokratio General Hospital, Thessaloniki, Greece 22nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece 3Organ Transplantation Unit, Hippokratio General Hospital, Thessaloniki, Greece Karagianni P, 19, G. Palama street, Thessaloniki, 54622, Tel:2310271108, 6973029192, [email protected] Copyright 2009, Hippokratio General Hospital of Thessaloniki This article has been cited by other articles in PMC. Background and aim: Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Daily insulin Injections (MDI) are both strategies aiming to achieve a tight glycemic and metabolic control. However, the choice between them remains controversial. The aim of the present study was to compare the efficacy of MDI (three or more injections daily) with CSII on glycemic control in patients with Type 1 Diabetes Mellitus and assess satisfaction from treatment in the CSII group. Material and Methods: Seventeen patients with Type 1 Diabetes Mellitus on CSII (previously on MDI) and 17 patients on MDI, matched for age, gender, BMI and duration of diabetes, were retrospectively studied. Glucosylated Hemoglobin A1c (HbA1c), frequency of hypoglycaemias (assessed as self reported episodes), BMI and total units of insulin per day were evaluated at baseline and after 6 months in both groups. CSII group completed a questionnaire concerning motive for treatment selection, advantages, deficiencies and inconvenience at the end of the study. Satisfaction from treatment was assessed with a scale from 0 to10. Results: CSII group had more hypoglycaemic episodes at baseline tha Continue reading >>

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