Comparison of Glycemic Control between Intensive Insulin Regimen and Continuous Subcutaneous Insulin infusion: A Meta-Analysis Report of Type-1 Diabetics from Randomized Controlled Trials

Abstract

AbstractAchieving glycemic control and targets are challenging in type-1 diabetes management. To achieve this, intensive insulin therapy or multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) or pump therapy have been used in various health care settings. However, there has been a debate on their superiority. Some of researchers have recommended MDI, while others SCII. We compared MDI with CSII by a literature search. We have conducted mata-analysis for MDI and CSII on ten randomized controlled trials on 809 type-1 diabetics 809, MDI (N = 394) or CSII (N = 415). Heterogeneity between trials was quantified by conventional Q-statistic (Cochran’s heterogeneity statistic) and Higgins I2 statistic with 0-40% representing negligible heterogeneity, 30-60% moderate heterogeneity, 50-90% substantial heterogeneity and 75-100% considerable heterogeneity. tau-squared (τ2) was used to observe between-study random-effects variance. Meta Analyst software was used to analyze the data and to conduct meta-analysis. SPSS was used to analyze HbA1c student’s t-test for MDI and CSII. A random-effect analysis ((DerSimonian-Laird method) performed on ten studies found that the percentage of HbA1c was lower in patients receiving CSII compared with those receiving MDI; standardized mean difference (SMD) was 0.441, 95% confidence interval 0.267 to 0.616, p < 0.001; equivalent to a difference of 0.39%, favoring CSII. I2 statistic was 20.9; τ2 = 0.016; Q = 11.378 with df = 9, indicating that heterogeneity was not significant (heterogeneity p-value = 0.251). Patients on CSII demonstrated significantly lower values (8.2±0.72 versus 7.73±0.72; p-value < 0.001 respectively). This statistical and meta-analysis favors the usage of insulin pump therapy. We concluded that patient centered approach should be used while selecting the patients for insulin pump (CSII) or MDI.