Insulin Pump Therapy
OBJECTIVE—To conduct a meta-analysis of the metabolic and psychosocial impact of continuous subcutaneous insulin infusion (CSII) therapy on adults, adolescents, and children.
RESEARCH DESIGN AND METHODS—Studies were identified and data regarding study design, year of publication, sample size, patient’s age, diabetes duration, and duration of CSII therapy were collected. Means and SDs for glycohemoglobin, blood glucose, insulin dosages, and body weight for CSII and comparison conditions were subjected to meta-analytic procedures. Data regarding pump complications and psychosocial functioning were reviewed descriptively.
RESULTS—A total of 52 studies, consisting of 1,547 patients, were included in the meta-analysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993.
CONCLUSIONS—CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.
- CSII, continuous subcutaneous insulin infusion
- CT, conventional therapy
- DCCT, Diabetes Control and Complications Trial
- DKA, diabetic ketoacidosis
- MDI, multiple daily injection
- UKPDS, U.K. Prospective Diabetes Study
Address correspondence and reprint requests to Jill Weissberg-Benchell, PhD, 2300 Children’s Plaza, Box 10, Chicago, IL 60614. E-mail:.
Received for publication 8 August 2002 and accepted in revised form 13 December 2002.
J.W.-B. is a co-investigator on a research project funded by the American Association of Diabetes Educators. The grant for this project was sponsored by MiniMed.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE