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Insulin pumps may be more effective than shots
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New evidence suggests that continuous subcutaneous insulin infusion may be more beneficial than multiple insulin injections for glycemic control in patients with type 1 diabetes.
"Good evidence is now available to support the use of continuous subcutaneous insulin infusion in the appropriate patient,” researcher Marie L. Misso, PhD, of the Australasian Cochrane Center at Monash University, Clayton, Australia, said in a press release. “It is essential to consider adverse events, late complications of diabetes, mortality and cost when deciding whether [a pump] is appropriate for the patient.”
To assess and compare the effects of continuous subcutaneous insulin infusion with multiple insulin injections, researchers studied 23 randomized controlled trials obtained in Cochrane, MEDLINE, EMBASE and other databases. All of the trials compared continuous subcutaneous insulin infusion with three or more insulin injections per day in patients with type 1 diabetes. Trials ranged in duration from six days to four years. Seven of the studies were performed in patients aged younger than 18 years.
The 23 trials included a total of 973 patients with type 1 diabetes randomized to either intervention.
Continuous subcutaneous insulin infusion users had significantly lower HbA1c levels compared with multiple insulin injection users (weighted mean difference, –0.3%; 95% CI, –0.1 to –0.4).
The review revealed no significant differences between the two methods in regards to non-severe hypoglycemia; however, continuous subcutaneous insulin infusion users appeared to have a reduction in severe hypoglycemia.
No considerable disparities were found for weight.
Overall review suggested that continuous subcutaneous insulin infusion is preferred over multiple insulin injections for patients with type 1 diabetes. For example, patients who use an insulin pump are able to circumvent the pain of multiple daily injections, according to the researchers.
The researchers said adverse events were not well reported for the review, and future studies should consider short- and long-term adverse events, morbidity, mortality and financial costs of these treatments.
Misso ML. Cochrane Database Syst Rev. 2010;doi:10.1002/14651858.CD005103.pub2.