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[IPk] Pickup in this week's BMJ

Article by Prof John Pickup in this week's BMJ:


Glycaemic control with continuous subcutaneous insulin infusion compared
with intensive insulin injections in patients with type 1 diabetes:
meta-analysis of randomised controlled trials

John Pickup, professor of diabetes and metabolism, a Martin Mattock, senior
research fellow, b Sally Kerry, lecturer in medical statistics. c

Correspondence to: J Pickup email @ redacted

Objective: To compare glycaemic control and insulin dosage in people with
type 1 diabetes treated by continuous subcutaneous insulin infusion
(insulin infusion pump therapy) or optimised insulin injections.

Design: Meta-analysis of 12 randomised controlled trials.

Participants: 301 people with type 1 diabetes allocated to insulin infusion
and 299 allocated to insulin injections for between 2.5 and 24 months.

Main outcome measures: Glycaemic control measured by mean blood glucose
concentration and percentage of glycated haemoglobin. Total daily insulin

Results: Mean blood glucose concentration was lower in people receiving
continuous subcutaneous insulin infusion compared with those receiving
insulin injections (standardised mean difference 0.56, 95% confidence
interval 0.35 to 0.77), equivalent to a difference of 1.0 mmol/l. The
percentage of glycated haemoglobin was also lower in people receiving
insulin infusion (0.44, 0.20 to 0.69), equivalent to a difference of 0.51%.
Blood glucose concentrations were less variable during insulin infusion.
This improved control during insulin infusion was achieved with an average
reduction of 14% in insulin dose (difference in total daily insulin dose
0.58, 0.34 to 0.83), equivalent to 7.58 units/day.

Conclusions: Glycaemic control is better during continuous subcutaneous
insulin infusion compared with optimised injection therapy, and less
insulin is needed to achieve this level of strict control. The difference
in control between the two methods is small but should reduce the risk of
microvascular complications.

** What is already known on this topic **

Continuous subcutaneous insulin infusion (insulin pump therapy) produces
good long term control of blood glucose concentrations in people with type
1 diabetes

Control of blood glucose concentration is substantially better on pump
therapy than conventional (non-optimised) injection therapy

It is unclear how glycaemic control on pump therapy compares with modern
optimised insulin injection regimens

** What this study adds **

Though glycaemic control was better during continuous subcutaneous insulin
infusion than optimised insulin injection therapy, the difference was
relatively small

Continuous subcutaneous insulin infusion is an effective form of intensive
insulin therapy that should lower the risk of microvascular complications

Insulin pump therapy is unnecessary for most people with type 1 diabetes
and should be reserved for those with special problems with optimised
insulin injections

) BMJ 2002

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