An appraisal of a 2010 systematic review of continuous subcutaneous insulin infusion (CSII, or insulin pumps) has been published in DARE.
In diabetes, does CSII as compared with multiple daily injections (MDI), improve the clinical or cost-effectiveness of care?
The review included both adults and children with type 1 or type 2 diabetes. The MDI comparators included newer insulin analogue regimens. Outcomes included glycaemic control, quality of life and hypoglycaemia.
The review found 16 RCTs and 48 observational studies. There was, predictably, a great deal of variation between them in terms of patient population, interventions being compared and outcomes assessed.
Several studies were found showing that CSII improved glycaemic control and reduced risk of hypoglycaemia in children. However, it was not clear what co-interventions were given alongside the pump therapy.
The authors concluded that:
CSII provided some advantages over MDI in adults and children with type I diabetes, including better control of glucose levels, fewer occurrences of hypoglycaemia, and quality of life gains in terms of greater flexibility of lifestyle.
This paper was appraised by the Centre for Reviews and Dissemination at York University. They concluded:
- The reviewers may have missed research that was published in languages other than English.
- The studies were of poor quality.
- Observed benefits of CSII may have been confounded by additional educational interventions.
- The authors’ conclusions should be treated with caution.
Cummins E, Royle P, Snaith A, Greene A, Robertson L, McIntyre L, Waugh N. Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation. Health Technology Assessment 2010; 14(11): 1-181