Abstract
Background: Continuous Subcutaneous Insulin Infusion (CSII) improves HbA1c in type 1 diabetic
patients unsatisfactorily controlled by Multiple Daily Injections (MDI). Few trials
have explored CSII for basal-bolus therapy in type 2 diabetes.
Materials and Methods: Randomized Clinical Trials (RCTs) comparing CSII and MDI for at least 12 weeks in
type 2 diabetic patients were retrieved, assessing between-group differences in HbA1c
and insulin daily dose at endpoint, and incidence of hypoglycemia.
Results: A total of 4 RCTs was included in the analysis. CSII did not produce any significant
improvement of HbA1c in comparison with MDI (Standardized difference in mean: 0.09(−0.08;0.26)%;
p=0.31). No significant difference was observed in the rate of hypoglycemic episodes.
CSII was associated with a nonsignificant trend toward the reduction of insulin doses
used at the end of trial.
Conclusions: Available data do not justify the use of CSII for basal-bolus insulin therapy in
type 2 diabetes.
Key words
meta-analysis - type 2 diabetes mellitus - continuous subcutaneous insulin infusion
References
- 1
Jeitler K, Horvath K, Berghold A. et al .
Continuous subcutaneous insulin infusion versus multiple daily insulin injections
in patients with diabetes mellitus: systematic review and meta-analysis.
Diabetologia.
2008;
51
941-951
- 2
Pickup JC, Renard E.
Long-acting insulin analogs versus insulin pump therapy for the treatment of type
1 and type 2 diabetes.
Diabetes Care.
2008;
31
((Suppl. 2))
S140-S145
- 3
Retnakaran R, Hochman J, DeVries JH. et al .
Continuous subcutaneous insulin infusion versus multiple daily injections: the impact
of baseline A1c.
Diabetes Care.
2004;
27
2590-2596
- 4
Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R.
Insulin pump therapy: a meta-analysis.
Diabetes Care.
2003;
26
1079-1087
- 5
Wainstein J, Metzger M, Boaz M. et al .
Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patients.
Diabet Med.
2005;
22
1037-1046
- 6
Weng J, Li Y, Xu W. et al .
Effect of intensive insulin therapy on beta-cell function and glycaemic control in
patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group
trial.
Lancet.
2008;
371
1753-1760
- 7
Herman WH, Ilag LL, Johnson SL. et al .
A clinical trial of continuous subcutaneous insulin infusion versus multiple daily
injections in older adults with type 2 diabetes.
Diabetes Care.
2005;
28
1568-1573
- 8
Raskin P, Bode BW, Marks JB. et al .
Continuous subcutaneous insulin infusion and multiple daily injection therapy are
equally effective in type 2 diabetes: a randomized, parallel-group, 24-week study.
Diabetes Care.
2003;
26
2598-2603
- 9
Siebenhofer A, Plank J, Berghold A. et al .
Short acting insulin analogues versus regular human insulin in patients with diabetes
mellitus.
Cochrane Database Syst Rev.
2006;
CD003287
Correspondence
E. MannucciMD
Department of Cardiovascular Medicine
Section of Geriatric Cardiology
Azienda Ospedaliero-Universitaria Careggi
Via delle Oblate 4: 50141 Florence
Italy
Phone: +39/055/794 95 98
Fax: +39/055/794 96 60
Email: edoardo.mannucci@unifi.it
Email: mmonami@libero.it
