Insulin injections, infusion pumps offer similar glucose control

Continuous insulin provides comparable glycemic control to injections, while continuous glucose monitoring is slightly superior to self-monitoring, a meta-analysis concluded.

Researchers conducted a meta-analysis of 33 randomized controlled trials in children or adults with type 1 or 2 diabetes. Results of the study, funded by the Agency for Healthcare Research and Quality, were published online July 10 by Annals of Internal Medicine.

In adults with type 1 diabetes, hemoglobin A1c (HbA1c) decreased more with continuous subcutaneous insulin infusion (CSII) than with multiple daily injections (MDIs), but study authors noted that results were heavily influenced by one study where participants had higher HbA1c values at enrollment. This allowed for greater HbA1c lowering compared with other studies where participants were closer to the target at enrollment. Glycemic control and hypoglycemia were similar for the two methods for patients with type 2 disease.

The researchers noted, “In comparison with MDI, CSII yielded better satisfaction with diabetes treatment in children with type 1 diabetes, and better diabetes-specific QOL [quality of life] in adults with type 1 diabetes, but the strength of evidence on QOL effects was low. The evidence was insufficient to draw definitive conclusions about other non-glycemic outcomes.”

Compared with self-monitoring of blood glucose (SMBG), real-time continuous glucose monitoring (rt-CGM) was associated with lower HbA1c values (between-arm difference of change, −0.26%; 95% CI, −0.33% to −0.19%), without any difference in severe hypoglycemia. The difference in HbA1c was statistically significant but smaller than the 0.5% difference researchers defined as clinically meaningful.

Patients with type 1 diabetes who used a sensor-augmented insulin pump had a statistically and clinically significant greater reduction in HbA1c than those using MDI/SMBG (between-arm difference in HbA1c reduction, −0.68%; 95% CI, −0.81% to −0.54%). The evidence was insufficient to draw definitive conclusions about pumps' effects on severe hypoglycemia or quality of life, the authors said.

They concluded, “From a patient-focused perspective, CSII yielded better satisfaction with diabetes treatment in children with type 1 diabetes, and better diabetes-specific QOL in adults with type 1 diabetes. These data suggest that the approach to intensive insulin therapy can be individualized to patient preference that will maximize their treatment satisfaction and QOL, as both MDI and rapid-acting analog-based CSII have similar effectiveness for glycemic control.”