What are the benefits of insulin pumps compared with multiple daily injections of insulin? This report by the US Agency for Healthcare Quality and Research summarises what the evidence says.
Clinical question:
In diabetics using insulin, does continuous subcutaneous insulin infusion (CSII), compared with multiple daily injections (MDI), improve quality of life or glycaemic control?
The review encompasses adults, children, type 1, type 2 and gestational diabetes.
The evidence:
The reviewers found 41 studies. They included both randomized trials and observational studies.
Glycaemic control (HbA1c)
When they combined the results, they found no evidence of benefit on HbA1c in children and adolescents with type 1 diabetes, nor in adults with type 2 diabetes. In adults with type 1 diabetes, CSII resulted in better glycemic control. However, the strength of the evidence for this finding was rated as “low”.
Quality of life
CSII was found to significantly improve quality of life in both adults and children with type 1 diabetes.
Appraisal hints:
- The search date was July 2011. New research may have been published since.
- The reviewers took account of the potential impact of variable study quality in their analysis.
- Sensor augmented pump therapy was considered to be better than other CSII methods.
- There remains a need for primary research in this area, particularly to establish cost-effectiveness.
- There was no evidence of an effect on the risk of hypoglycemia.
Reference:
Golden SH, Brown T, Yeh HC, Maruthur N, Ranasinghe P, Berger Z, Suh Y, Wilson LM, Haberl EB, Bass EB. Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Jul. Report No.: 12-EHC036-EF.
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.
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