title: Comparative effectiveness of continuous subcutaneous insulin infusion using insulin analogs and multiple daily injections in pregnant women with diabetes mellitus: a systematic review and meta-analysis.
abstract: We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
authors.affiliation: 1 Department of Medicine, Johns Hopkins University , Baltimore, Maryland.
authors.forename: Padmini D
authors.initials: PD
authors.lastname: Ranasinghe
authors.forename: Nisa M
authors.initials: NM
authors.lastname: Maruthur
authors.forename: Wanda K
authors.initials: WK
authors.lastname: Nicholson
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Todd
authors.initials: T
authors.lastname: Brown
authors.forename: Yong
authors.initials: Y
authors.lastname: Suh
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wilson
authors.forename: Elisabeth B
authors.initials: EB
authors.lastname: Nannes
authors.forename: Zack
authors.initials: Z
authors.lastname: Berger
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D055104:Infusions, Subcutaneous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011254:Pregnancy in Diabetics / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin