Insulin Delivery, Glucose Monitoring Methods Compared
(HealthDay News) – Continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) offer similar improvements in glycemic control in adults with type 1 diabetes, while the addition of real-time continuous glucose monitoring (rt-CGM) improves glycemic control compared with MDI or self-monitored blood glucose (SMBG).
Hsin-Chieh Yeh, PhD, of Johns Hopkins University in Baltimore, and colleagues conducted a systematic review and meta-analysis of the literature to investigate how intensive insulin therapy or mode of monitoring affects outcome in children and adults with type 1 or 2 diabetes.
The researchers identified 33 randomized controlled trials that compared insulin therapies. For adults with type 2 diabetes and adults and children with type 1 diabetes, MDI and CSII exhibited similar effects on hemoglobin A1c (HbA1c) and severe hypoglycemia. For adults with type 1 diabetes, HbA1c decreased more with CSII than MDI, although one study heavily influenced results. Real-time CGM was associated with a 0.26% lower HbA1c compared with SMBG, without any increase in severe hypoglycemia episodes. In type 1 diabetes, HbA1c was reduced more with sensor-augmented pump use than with MDI and SMBG (between-group difference of change, −0.68%).
"Even though CSII and MDI without rt-CGM have similar effects on HbA1c, the addition of rt-CGM to CSII is superior to MDI/SMBG in lowering HbA1c," the authors write. "Thus, the addition of this monitoring method to SMBG and intensive insulin therapy can assist in achieving glycemic targets in type 1 diabetes."
One author disclosed financial ties to several pharmaceutical and biotechnology companies.