PMID- 19088167
OWN - NLM
STAT- MEDLINE
DCOM- 20090407
LR  - 20221207
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Linking)
VI  - 94
IP  - 3
DP  - 2009 Mar
TI  - Clinical review: Hypoglycemia with intensive insulin therapy: a systematic review 
      and meta-analyses of randomized trials of continuous subcutaneous insulin 
      infusion versus multiple daily injections.
PG  - 729-40
LID - 10.1210/jc.2008-1415 [doi]
AB  - CONTEXT: Hypoglycemia limits the efficacy of intensive insulin therapy. The 
      extent to which continuous insulin infusion (CSII) overcomes this limitation is 
      unclear. OBJECTIVE: The aim was to summarize evidence on the effect of CSII and 
      multiple daily injections (MDIs) on glycemic control and hypoglycemia. DATA 
      SOURCES: We searched electronic databases between 2002 and March 2008. STUDY 
      SELECTION: We selected published randomized trials of CSII vs. MDI. DATA 
      EXTRACTION: Reviewers working in duplicate and independently extracted study 
      characteristics and quality and differences in glycosylated hemoglobin (HbA1c) 
      and hypoglycemic events. DATA SYNTHESIS: We found 15 eligible randomized trials 
      of moderate quality, with elevated baseline and end-of-study HbA1c levels. 
      Patients with type 1 diabetes using CSII had slightly lower HbA1c [random-effects 
      weighted mean difference, -0.2%; 95% confidence interval (CI), -0.3, -0.1, 
      compared with MDI], with no significant difference in severe (pooled odds ratio, 
      0.48; 95% CI, 0.23, 1.00) or nocturnal hypoglycemia (pooled odds ratio 0.82, 95% 
      CI 0.33, 2.03). Adolescents and adults with type 1 diabetes enrolled in crossover 
      trials had nonsignificantly fewer minor hypoglycemia episodes per patient per 
      week (-0.08; 95% CI, -0.21, 0.06) with CSII than MDI; children enrolled in 
      parallel trials had significantly more episodes (0.68; 95% CI, 0.16, 1.20; 
      P(interaction) = 0.03). Outcomes were not different in patients with type 2 
      diabetes. CONCLUSIONS: Contemporary evidence indicates that compared to MDI, CSII 
      slightly reduced HbA1c in adults with type 1 diabetes, with unclear impact on 
      hypoglycemia. In type 2 diabetes, CSII and MDI had similar outcomes. The effect 
      in patients with hypoglycemia unawareness or recurrent severe hypoglycemia 
      remains unclear because of lack of data.
FAU - Fatourechi, Mitra M
AU  - Fatourechi MM
AD  - Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
FAU - Kudva, Yogish C
AU  - Kudva YC
FAU - Murad, M Hassan
AU  - Murad MH
FAU - Elamin, Mohamed B
AU  - Elamin MB
FAU - Tabini, Claudia C
AU  - Tabini CC
FAU - Montori, Victor M
AU  - Montori VM
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20081216
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Diabetes Mellitus/*drug therapy
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Hypoglycemia/chemically induced/*prevention & control
MH  - Hypoglycemic Agents/*administration & dosage/adverse effects
MH  - Insulin/*administration & dosage/adverse effects
MH  - *Insulin Infusion Systems
MH  - Randomized Controlled Trials as Topic
RF  - 32
EDAT- 2008/12/18 09:00
MHDA- 2009/04/08 09:00
CRDT- 2008/12/18 09:00
PHST- 2008/12/18 09:00 [entrez]
PHST- 2008/12/18 09:00 [pubmed]
PHST- 2009/04/08 09:00 [medline]
AID - jc.2008-1415 [pii]
AID - 10.1210/jc.2008-1415 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2009 Mar;94(3):729-40. doi: 10.1210/jc.2008-1415. Epub 
      2008 Dec 16.