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Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness

Slide: 15 of 25

Insulin Delivery With MDI Versus CSII in Adults With Type 2 Diabetes

There was moderate strength of evidence that there was no significant difference in HbA1c lowering between MDI and CSII arms in adults with type 2 diabetes.

  • A meta-analysis of four randomized controlled trials of at least 18 weeks in duration showed a mean decrease from baseline in HbA1c in both the CSII and MDI treatment groups, with a greater reduction during CSII treatment than with MDI; however, there was no significant difference between the two groups (combined mean between-group difference, -0.16%; 95% CI, -0.42 to 0.09%; p = 0.21).

There was moderate strength of evidence that the risk of hypoglycemia was similar in the MDI and CSII groups in adults with type 2 diabetes.

  •  In a meta-analysis of two studies, the combined risk of mild hypoglycemia was lower with CSII when compared with MDI (combined RR, 0.90; 95% CI, 0.78 to 1.03); however, there was no significant difference between the groups.

The incidence of severe hypoglycemia was not significantly different between the MDI and CSII groups in adults with type 2 diabetes. The strength of evidence was rated low for this finding.

  • In a meta-analysis of two studies, the combined RR was 0.76 (95% CI, 0.26 to 2.19).

Two studies evaluated weight gain experienced by participants using MDI or CSII and did not find a significant effect of the treatments on weight gain (combined between-group difference in weight change from baseline for CSII vs. MDI, -0.49 kg; 95% CI, -1.25 to 0.26 kg). The strength of evidence was rated low for this finding.

Abbreviations: 95% CI = 95-percent confidence interval; CSII = continuous subcutaneous insulin infusion; HbA1c = hemoglobin A1c; MDI = multiple daily injections; RR = relative risk