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

Slide: 21 of 25

Knowledge Gaps and Future Research Needs (1 of 3)

Several shortcomings and gaps in knowledge were identified in the studies included in this systematic review and meta-analysis:

  • Most randomized controlled trials examining the effect of insulin delivery and glucose monitoring devices were small, with the largest trial including 322 participants.
  • Most studies, particularly those comparing CSII with MDI, were fair to poor in quality and did not report most quality outcomes of interest.
  • Most studies did not report the racial and ethnic composition of the study populations; however, for those that did, most participants were white. There were limited participants from other ethnic groups in which type 2 diabetes is more prevalent.
  • Few studies focused on or included children 12 years of age or younger, adults 65 years of age or older, or pregnant women with pre-existing type 2 diabetes, thus precluding definitive conclusions about the effectiveness of insulin delivery and glucose monitoring methods in these populations. This likely reflects the rarity of type 1 diabetes in children 12 years of age and younger and in elderly individuals and the fact that few pregnant women have pre-existing type 2 diabetes, thereby making it less feasible and less relevant to perform studies in these subpopulations.
  • The studies were heterogeneous in their definitions of nonsevere hypoglycemia, hyperglycemia, and weight gain, thus preventing the combination of data to determine effect estimates for these intermediate outcomes. For example, while the definition of severe hypoglycemia in many studies included a requirement for third-party assistance, it was not explicitly stated in all studies.

Abbreviations: CSII = continuous subcutaneous insulin infusion; MDI = multiple daily injections; SMBG = self-monitoring of blood glucose