Skip to main content

Advertisement

Log in

Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Continuous subcutaneous insulin infusion (CSII) is considered an option for type 1 diabetic patients unsatisfactorily controlled with multiple daily injections (MDI). Short-acting analogs are superior to regular human insulin in CSII. This meta-analysis is aimed at assessing the advantages of short-acting analog-based CSII over MDI in type 1 diabetes. Randomized clinical trials (RCTs) comparing CSII (with analogs) and MDI for at least 12 weeks in type 1 diabetic patients were retrieved, assessing between-group differences in HbA1c and incidence of hypoglycemia. A total of 11 RCTs was included in the analysis. CSII was associated with a significant improvement of HbA1c in comparison with MDI (standardized difference in mean: −0.3 [−0.4;−0.1]%; P < 0.001). No significant difference was observed in the rate of severe hypoglycemic episodes. The reduction of HbA1c with CSII was evident in trials enrolling patients with mean age greater than 10 years, but not in younger children. Available data justify the use of CSII for basal-bolus insulin therapy in type 1 diabetic patients unsatisfactorily controlled with MDI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pickup JC, Renard E (2008) Long-acting insulin analogs versus insulin pump therapy for the treatment of type 1 and type 2 diabetes. Diabetes Care 31(Suppl 2):S140–S145

    Article  PubMed  Google Scholar 

  2. Weissberg-Benchell J, Ntisdel-Lomaglio J, Seshadri R (2003) Insulin pump therapy: a meta-analysis. Diabet Care 26:1079–1087

    Article  Google Scholar 

  3. Siebenhofer A, Plank J, Berghold A, Jeitler K, Horvath K, Narath M, Gfrerer R, Pieber TR (2006) Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev CD003287

  4. Colquitt J, Royle P, Waugh N (2003) Are analogue insulins better than soluble in continuous subcutaneous insulin infusion? Results of a meta-analysis. Diabet Med 20:863–866

    Article  CAS  PubMed  Google Scholar 

  5. Siebenhofer A, Plank J, Berghold A, Jeitler K, Horvath K, Narath M, Gfrerer R, Pieber TR (2006) Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev CD003287

  6. Fox LA, Buckloh LM, Smith SD, Wysocki T, Mauras N (2005) A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes. Diabet Care 28:1277–1281

    Article  CAS  Google Scholar 

  7. DiMeglio LA, Pottorff TM, Boyd SR, France L, Fineberg N, Eugster EA (2004) A randomized, controlled study of insulin pump therapy in diabetic preschoolers. J Pediatr 145:380–384

    Article  CAS  PubMed  Google Scholar 

  8. Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP (2000) Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens using insulin lispro in type 1 diabetic patients on intensified treatment: a randomized study. The Study Group for the Development of Pump Therapy in Diabetes. Diabet Care 23:1232–1235

    Article  CAS  Google Scholar 

  9. Hoogma RP, Hammond PJ, Gomis R, Kerr D, Bruttomesso D, Bouter KP, Wiefels KJ, de la CH, Schweitzer DH, Pfohl M, Torlone E, Krinelke LG, Bolli GB (2006) Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med 23:141–147

    Article  CAS  PubMed  Google Scholar 

  10. Opipari-Arrigan L, Fredericks EM, Burkhart N, Dale L, Hodge M, Foster C (2007) Continuous subcutaneous insulin infusion benefits quality of life in preschool-age children with type 1 diabetes mellitus. Pediatr Diabet 8:377–383

    Article  Google Scholar 

  11. Thomas RM, Aldibbiat A, Griffin W, Cox MA, Leech NJ, Shaw JA (2007) A randomized pilot study in Type 1 diabetes complicated by severe hypoglycaemia, comparing rigorous hypoglycaemia avoidance with insulin analogue therapy, CSII or education alone. Diabet Med 24:778–783

    Article  CAS  PubMed  Google Scholar 

  12. Tsui E, Barnie A, Ross S, Parkes R, Zinman B (2001) Intensive insulin therapy with insulin lispro: a randomized trial of continuous subcutaneous insulin infusion versus multiple daily insulin injection. Diabet Care 24:1722–1727

    Article  CAS  Google Scholar 

  13. Wilson DM, Buckingham BA, Kunselman EL, Sullivan MM, Paguntalan HU, Gitelman SE (2005) A two-center randomized controlled feasibility trial of insulin pump therapy in young children with diabetes. Diabet Care 28:15–19

    Article  Google Scholar 

  14. Weintrob N, Benzaquen H, Galatzer A, Shalitin S, Lazar L, Fayman G, Lilos P, Dickerman Z, Phillip M (2003) Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: a randomized open crossover trial. Pediatrics 112:559–564

    Article  PubMed  Google Scholar 

  15. Pozzilli P, Crino A, Schiaffini R, Manfrini S, Fioriti E, Coppolino G, Pitocco D, Visalli N, Corbi S, Spera S, Suraci C, Cervoni M, Matteoli MC, Patera IP, Ghirlanda G (2003) A 2-year pilot trial of continuous subcutaneous insulin infusion versus intensive insulin therapy in patients with newly diagnosed type 1 diabetes (IMDIAB 8). Diabet Technol Ther 5:965–974

    Article  CAS  Google Scholar 

  16. Bruttomesso D, Crazzolara D, Maran A, Costa S, Dal PM, Girelli A, Lepore G, Aragona M, Iori E, Valentini U, Del PS, Tiengo A, Buhr A, Trevisan R, Baritussio A (2008) In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine. Diabet Med 25:326–332

    Article  CAS  PubMed  Google Scholar 

  17. DeVries JH, Snoek FJ, Kostense PJ, Masurel N, Heine RJ (2002) A randomized trial of continuous subcutaneous insulin infusion and intensive injection therapy in type 1 diabetes for patients with long-standing poor glycemic control. Diabet Care 25:2074–2080

    Article  CAS  Google Scholar 

  18. Doyle EA, Weinzimer SA, Steffen AT, Ahern JA, Vincent M, Tamborlane WV (2004) A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabet Care 27:1554–1558

    Article  CAS  Google Scholar 

  19. Retnakaran R, Hochman J, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V, Zinman B (2004) Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c. Diabet Care 27:2590–2596

    Article  CAS  Google Scholar 

  20. Jeitler K, Horvath K, Berghold A, Gratzer TW, Neeser K, Pieber TR, Siebenhofer A (2008) Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia 51:941–951

    Article  CAS  PubMed  Google Scholar 

  21. Monami M, Marchionni N, Mannucci E (2009) Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis. Diabetes Obes Metab [Epub ahead of print]

  22. Lapolla A, Dalfrà MG, Masin M, Bruttomesso D, Piva I, Crepaldi C, Tortul C, Dalla Barba B, Fedele D (2003) Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy. Acta Diabetol 40:143–149

    Article  CAS  PubMed  Google Scholar 

  23. Cimino A, Valentini U, Rotondi A, Candrina R, Salvi A, Spandrio S, Radaeli E, Giustina G (1987) Continuous basal insulin infusion without premeal boluses in insulin-dependent diabetes mellitus therapy. Acta Diabetol Lat 24:193–198

    Article  CAS  PubMed  Google Scholar 

  24. Hofmann HM, Weiss PA, Haas JG (1986) Continuous insulin delivery systems for the pregnant diabetic patient. Acta Diabetol Lat 23:201–214

    Article  CAS  PubMed  Google Scholar 

  25. Gimenez M, Conget I, Nicolau J, Pericot A, Levy I (2007) Outcome of pregnancy in women with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion or conventional therapy. A case-control study. Acta Diabetol 44:34–37

    Article  CAS  PubMed  Google Scholar 

  26. Colino E, Álvarez MA, Carcavilla A, Alonso M, Ros P, Barrio R (2009) Insulin dose adjustment when changing from multiple daily injections to continuous subcutaneous insulin infusion in the pediatric age group. Acta Diabetol. doi:10.1007/s00592-009-0103-x

  27. Pankowska E, Blazik M, Dziechciarz P, Szypowska A, Szajewska H (2009) Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials. Pediatr Diabet 10(5):2–58

    Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the technical support of Mrs. Rossella Del Bianco and Dr. Cristina Marchi in the preparation and revision of the manuscript.

Conflict of interest statement

No financial supports were requested from this manuscript and authors did not receive any compensation for their contribution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edoardo Mannucci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monami, M., Lamanna, C., Marchionni, N. et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis. Acta Diabetol 47 (Suppl 1), 77–81 (2010). https://doi.org/10.1007/s00592-009-0132-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-009-0132-5

Keywords

Navigation