Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Type 2 Diabetes: A Meta-analysis

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