Unclear evidence from a poor quality review of insulin pump therapy in children.

Insulin pump therapy, or Continuous Subcutaneous Insulin Infusion (CSII), has many potential benefits for children with type 1 diabetes.  This review set out to summarise the clinical effects compared with multiple daily injections (MDI) of insulin lispro.

Clinical question:

In children and adolescents with type 1 diabetes, how effective is delivery of insulin lispro by CSII, compared with multiple daily injections (MDI)?

The review does not clearly state whether outcomes of interest were specified in advance of the search.

The evidence:

The reviewers found twenty-six studies involving 2,521 patients with type 1 diabetes . 10 of these were randomized controlled trials (RCT).

The reviewers report that insulin lispro by CSII and MDI showed similar HbA1c and rates of hypoglycemia and diabetic ketoacidosis.  However, too few details are provided in the abstract.

Appraisal hints

Users of this review should consider:

  • Did the review address a clearly defined question?
  • Did the reviewers prospectively define a clear protocol for the systematic review and adhere to it?
  • A comprehensive search was not performed (PubMed only). It seems likely that important studies exist that were not found by the reviewers.
  • It is not clear what quality assessment procedures were applied to the studies.  It is clear that non-randomised trials were included, however.
  • Neither is it clear whether the reviewerss conclusions are based on meta-analysis of the study data.
  • On the face of this, this looks like a poor quality systematic review. Is it better to look for a good quality individual trial that focuses on the outcomes of interest to you?


The full text of this review is not available without subscription or payment.

Kaiserman K, Rodriguez H, Stephenson A, Wolka L, Fahrbach JL. Continuous Subcutaneous Insulin Infusion of Insulin Lispro in Children and Adolescents with Type 1 Diabetes. Endocr Pract. 2012 Jan 31:1-24. [Epub ahead of print]

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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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