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

Slide: 22 of 25

Knowledge Gaps and Future Research Needs (2 of 3)

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

  • None of the studies identified for inclusion in this review reported data on long-term microvascular and macrovascular complications of diabetes. This is likely related to the fact that these complications develop over many years, and the longest followup in the studies analyzed was 52 weeks.
  • None of the studies in women with pre-existing type 1 diabetes identified for inclusion in this review have examined the effect of rt-CGM on maternal and fetal outcomes.
  • Other than the rt-CGM studies, most studies did not report data on treatment adherence. The high baseline HbA1c values in the CSII and MDI intervention groups in many studies may indicate poor adherence to previous as well as intervention treatments that may have biased results.
  • The studies included in this review were heterogeneous in assessing and reporting quality-of-life outcomes, which prevented quantification of the effects of insulin delivery and glucose monitoring methods on quality of life.
  • No studies examining the effects of CSII versus MDI on quality of life in pregnant women were identified, and only one study examining the effects of these interventions on quality of life in individuals with type 2 diabetes was identified.

Abbreviations: CSII = continuous subcutaneous insulin infusion; HbA1c = hemoglobin A1c; MDI = multiple daily injections; rt-CGM = real time-continuous glucose monitoring