PMID- 34535888
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20220323
IS  - 1720-8386 (Electronic)
IS  - 0391-4097 (Linking)
VI  - 45
IP  - 3
DP  - 2022 Mar
TI  - Efficacy and safety of closed-loop insulin delivery versus sensor-augmented pump 
      in the treatment of adults with type 1 diabetes: a systematic review and 
      meta-analysis of randomized-controlled trials.
PG  - 471-481
LID - 10.1007/s40618-021-01674-6 [doi]
AB  - BACKGROUND: Controversy remains regarding whether closed-loop (CL) insulin 
      delivery or insulin sensor-augmented pump (SAP) delivery is more efficient for 
      clinical treatment. Therefore, we aimed to compare the efficacy and safety of CL 
      insulin delivery systems versus insulin SAP delivery for adults with type 1 
      diabetes (T1D). METHODS: Embase, Ovid MEDLINE, PubMed, ScienceDirect, Scopus, the 
      Cochrane Library, and other databases were searched for related articles, and we 
      analyzed the average blood glucose (BG), time in range (TIR), and adverse effects 
      (AEs) as primary endpoints to evaluate efficacy and safety. RESULTS: Of 1616 
      articles, 12 randomized-controlled trials (RCTs) were included in the final 
      analysis. Regarding BG control efficacy, CL insulin delivery resulted better 
      outcomes than SAP therapy with regard to the average BG value, which was detected 
      and recorded by continuous glucose monitoring (mean difference [MD][mmol/L]: 
       - 0.25 95% confidence interval [CI]  - 0.42 to - 0.08, p = 0.003); TIR 
      3.9-10 mmol/L (MD [%]: 7.91 95% CI 4.45-11.37, p < 0.00001). Similar results were 
      observed for the secondary outcomes including low blood glucose index (LBGI) (MD: 
       - 0.41 95% CI - 0.55 to - 0.26, p < 0.00001), high blood glucose index (HBGI) 
      (MD:  - 2.56 95% CI - 3.38 to - 1.74, p < 0.00001), and standard deviation (SD) 
      of glucose variability (MD [mmol/L]: -0.25 95% CI - 0.44 to - 0.06, p = 0.01). 
      Furthermore, SAP therapy was associated with more adverse effects (risk ratio: 
      0.20 95% CI 0.07-0.52, p = 0.001) than CL insulin delivery, and one of the most 
      common adverse effects was hypoglycemia. CONCLUSIONS: CL insulin delivery appears 
      to be a better treatment method than SAP therapy for adults with T1D because of 
      its increased BG control efficacy and decreased number of hypoglycemic events.
CI  - (c) 2021. Italian Society of Endocrinology (SIE).
FAU - Fang, Z
AU  - Fang Z
AD  - Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang 
      University, 1 Minde Road, Nanchang, 330006, China.
AD  - Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
FAU - Liu, M
AU  - Liu M
AD  - Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
AD  - Department of Endocrinology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, 330006, China.
FAU - Tao, J
AU  - Tao J
AD  - Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
AD  - Department of Endocrinology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, 330006, China.
FAU - Li, C
AU  - Li C
AD  - Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
AD  - Department of Endocrinology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, 330006, China.
FAU - Zou, F
AU  - Zou F
AD  - Department of Endocrinology, The Second Affiliated Hospital of Nanchang 
      University, Nanchang, 330006, China.
FAU - Zhang, W
AU  - Zhang W
AUID- ORCID: 0000-0003-2962-0847
AD  - Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang 
      University, 1 Minde Road, Nanchang, 330006, China. zwx123dr@126.com.
LA  - eng
GR  - 81560345/national natural science foundation of china/
GR  - 20181BAB215027/natural science foundation of jiangxi province/
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210917
PL  - Italy
TA  - J Endocrinol Invest
JT  - Journal of endocrinological investigation
JID - 7806594
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - *Diabetes Mellitus, Type 1/blood/drug therapy
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/adverse effects/classification
MH  - Patient Safety
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Closed-loop insulin delivery
OT  - Meta-analysis
OT  - Sensor-augmented pump
OT  - Systematic review
OT  - Type 1 diabetes
EDAT- 2021/09/19 06:00
MHDA- 2022/03/24 06:00
CRDT- 2021/09/18 06:21
PHST- 2021/07/22 00:00 [received]
PHST- 2021/09/02 00:00 [accepted]
PHST- 2021/09/19 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
PHST- 2021/09/18 06:21 [entrez]
AID - 10.1007/s40618-021-01674-6 [pii]
AID - 10.1007/s40618-021-01674-6 [doi]
PST - ppublish
SO  - J Endocrinol Invest. 2022 Mar;45(3):471-481. doi: 10.1007/s40618-021-01674-6. 
      Epub 2021 Sep 17.