Evidence base: Type-1 diabetes mellitus

Keep up to date with the latest evidence for the management of type-1 diabetes mellitus.

Insulin replacement therapy (Photograph: SPL)
Insulin replacement therapy (Photograph: SPL)

Clinical trials

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.

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.

Guidelines

NICE. Type-1 diabetes: diagnosis and management of type-1 diabetes in children, young people and adults. CG15. London, NICE, 2004.

Online

This website provides useful links for both patients and healthcare professionals in the UK.

 

Contributed by Dr Anita Pillai, specialist registrar, and Dr Iskandar Idris, consultant, Sherwood Forest Hospitals Foundation Trust, and honorary senior lecturer, University of Sheffield 


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