A Cochrane review in 2008 analysed 23 RCTs where two insulin regimens were used for a period ranging from three months to one year.11
The weighted mean difference for the level of glycosylated haemoglobin was -0.08 (95 per cent confidence interval (CI) -0.12 to -0.04) in favour of the long acting insulin arm, but the observed difference was of doubtful clinical significance.
Longer acting insulins were superior mostly in their nocturnal effect, which resulted in a lower level of fasting glucose levels and fewer episodes of nocturnal hypoglycaemia.
- Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials.
A meta-analysis of 12 trials found that glycaemic control was better with CSII compared with multiple daily injections in patients who had severe hypoglycaemia, with a difference in HbA1c of 0.51 per cent.12
The study also reported a threefold reduction in severe hypoglycaemia with CSII compared with multiple daily injections.
Another systematic review and meta-analysis of 20 studies reported that achieved HbA1c was significantly superior in the CSII group, the mean difference was -0.3 per cent (95 per cent CI -0.4 to -0.1, p=0.001) with significant reduction in the incidence of severe hypoglycemia.13 Thus, CSII is likely to be a clinically useful alternative for those patients in whom there is concern about severe hypoglycaemia.
NICE. Type-1 diabetes: diagnosis and management of type-1 diabetes in children, young people and adults. CG15. London, NICE, 2004.
- Diabetes UK www.diabetes.org.uk
This website provides useful links for both patients and healthcare professionals in the UK.
- American Diabetes Association www.diabetes.org
Contributed by Dr Anita Pillai, specialist registrar, and Dr Iskandar Idris, consultant, Sherwood Forest Hospitals Foundation Trust, and honorary senior lecturer, University of Sheffield