Managing diabetes in adults : continous subcutaneous insulin infusion versus multiple daily insulin injections

Abstract

Diabetes is one the chronic diseases in modem history that is quickly turning into a word spread plague affecting people of all ages especially adults and older adults. Caused by a defect in the insulin production by the beta cells in the pancreases diabetes can deteriorate if not taken care of causing systemic problems. This study aims to see whether continuous insulin infusion can be more effective than multiple daily insulin injection in adults. The population studied was that of adults defined by the WHO as people between 18 and 65 (http://www.who.int/healthinfo/survey/ageing/en/). The intervention studied was the use of continuous insulin infusion (CSII),compared to multiple daily insulin injections (MDII) to see which one provides the best control of blood glucose. CASP tools were used to enable the appraisal of the sixteen articles found making sure that the best studies are used to provide the best results. Out of the sixteen studies found, three were systematic reviews (Colquitt et al (2004), Jeitler et al (2008) and Retnakaran et al (2004)), Seven were randomized control trials (Bolli et al (2009), DeVries et al (2002), Wainstein et al (2005), Tsui et al (2001), Raskin et al (2003), Hirsch et al (2005) and Hoogam et al (2006)), four were cohorts (Hoogma et al (2004), Rodrigues et al (2004), Linkeschova et al (2002) and Bruttomesso et al (2002)) and the remaining two were economical reviews (Scuffham and Carr (2003) and Charles et al (2008)). The relative benefit of the continuous insulin infusion compared to multiple daily insulin injections seemed to increase with a higher baseline glycolated haemolgobin. Thus professionals should be aware and informed of the benefits of the pump and when it is best used to provide better treatment to their patients. In Malta a pilot study is needed to compare the local results with those of abroad and see if continuous insulin infusion should be introduced in as an alternative treatment for diabetes.