Optimizing type 1 diabetes after multiple daily injections and capillary blood monitoring: Pump or sensor first? A meta‐analysis using pooled differences in outcome measures

Jul 21, 2021Diabetes, obesity & metabolism

Improving type 1 diabetes management with injections and blood checks: Should insulin pumps or glucose sensors be used first? A combined analysis of results

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Abstract

Glycated haemoglobin levels were significantly reduced by CGM compared to SMBG.

Continuous glucose monitoring (CGM) led to a greater reduction in glycated haemoglobin compared to self-monitoring of blood glucose (SMBG).
Continuous subcutaneous insulin infusion (CSII) also reduced glycated haemoglobin compared to multiple daily injections (MDI), but to a lesser extent than CGM.
Severe hypoglycaemia rates decreased significantly with CGM compared to SMBG, while CSII did not show a change in severe hypoglycaemia rates compared to MDI.
The likelihood of diabetic ketoacidosis was higher with CSII than with MDI.
Both CSII and CGM reduced glucose variability compared to MDI and SMBG, respectively.

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AIMS: Most people living with type 1 diabetes self-manage using multiple daily injection (MDI) insulin regimens and self-monitoring of blood glucose (SMBG). Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) are adjuncts to education and support self-management optimization. The aim of this systematic review and meta-analysis was to assess which first-line technology is most effective.

METHODS: Electronic databases (MEDLINE, EMBASE and WEB OF SCIENCE) were systematically searched from 1999 to September 2020. Randomized controlled trials comparing either CSII with MDI or CGM with SMBG in adults with type 1 diabetes were included. Data were extracted in duplicate by two reviewers, and were analysed to assess individual and overall treatment effect measures (PROSPERO registration: CRD42020149915).

RESULTS: Glycated haemoglobin was significantly reduced for CGM when compared with SMBG [Cohen's d - 0.62 (95% CI -0.79 to -0.45)] and for CSII when compared with MDI [Cohen's d - 0.44 (95% CI -0.67 to -0.22)]. Rates of severe hypoglycaemia were significantly reduced with CGM compared with SMBG, but did not change for CSII when compared with MDI. Episodes of diabetic ketoacidosis were more likely to occur with CSII than MDI. Both CSII and CGM reduced glucose standard deviation, compared with MDI and SMBG respectively.

CONCLUSIONS: Both CGM and CSII remain impactful interventions compared with SMBG and MDI but in adults with type 1 diabetes and in the contexts in which they have been studied, CGM might have a greater positive impact on glycaemic variability and severe hypoglycaemia than CSII, when added to MDI and SMBG. A head-to-head study, including patient reported outcomes, is required to explore these findings further.

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Optimizing type 1 diabetes after multiple daily injections and capillary blood monitoring: Pump or sensor first? A meta‐analysis using pooled differences in outcome measures

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