Managing diabetes in young persons : continuous subcutaneous insulin versus multiple daily injections

Abstract

0.1. Overview of the topic: Tight metabolic control during the pre-pubertal and pubertal years has been found to reduce diabetes-related complications later in life. Different forms of intensive insulin therapies, including multiple daily injection and continuous subcutaneous insulin infusion are available which offer the hope for an improved glycemic control. 0.2. Research question: Is continuous subcutaneous insulin infusion therapy (CSII) more effective than multiple daily injection therapy (MDI) , for the management of type 1 diabetes, in children and youths? 0.3. PICO elements: Population -children and youths aged between 18 months and 21 years with TlDM, Intervention- CSII, Comparison- MDI, and Outcome- improved management of glucose levels/control. 0.4. Inclusion criteria: Studies published from 1990 onwards, comparing CSII with MDI in TlDM, considering toddlers, children, adolescents and young adults as a population, investigating metabolic control as outcome measure and classified as randomized controlled trials (RCT's), Systematic reviews, Matched pair studies and Multicentre studies. 0.5. Exclusion criteria: Studies not in English, considering adults and neonates as a population, investigating only cost effectiveness and quality of life as outcome measure and classified as retrospective chart reviews and descriptive studies. 0.6. Outcome of the search: Titles and abstracts of 72 articles were reviewed for relevance. Ultimately, 14 articles were appraised, 9 of which were RCT's, 1 was a systematic review and 4 were matched pair studies, 1 of which also had a multicentre approach. 0.7. Methods of appraisal used: CASP tools for RCT's and systematic reviews 0.8. Main results: CSII is at least as effective as MDI but no more so in achieving glucose control or in preventing complications. Nevertheless, there seems to be higher treatment satisfaction and an increased flexibility in lifestyle when using CSII. 0.9. Conclusion, implications and recommendations: Since CSII has been found to be at least as effective as MDI but no more so in achieving glucose control or in preventing complications, it may be offered to individuals who would prefer this method of insulin delivery for personal reasons such as convenience. However, further research is needed to identify candidates who would benefit most from this therapy.