Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 2 diabetes: a meta-analysis.
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.


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.
Monami
M
M
Section of Geriatric Cardiology, Department of Cardiovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, Florence, Italy. mmonami@libero.it
Lamanna
C
C
Marchionni
N
N
Mannucci
E
E
D000284:Administration, Oral; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin