Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness
Glucose Monitoring With rt-CGM Plus CSII (Sensor-Augmented Pump) Versus MDI Plus SMBG in Children and Adults With Type 1 Diabetes (1 of 2)
There was moderate strength of evidence that use of a sensor-augmented pump is associated with a significant HbA1c-lowering effect when compared with SMBG in children and adults with type 1 diabetes.
- A meta-analysis of four studies showed a significant difference in the reduction from baseline HbA1c between the sensor-augmented pump and the MDI/SMBG groups favoring the sensor-augmented pump (combined mean between-group difference from baseline, -0.68%; 95% CI, -0.81 to -0.54%; p < 0.001). The study duration for these three trials ranged between 15 and 52 weeks.
The strength of evidence was rated moderate for the lack of difference in time spent with nonsevere hypoglycemia and the incidence of severe hypoglycemia between the sensor-augmented pump and the MDI/SMBG groups. Definitions of nonsevere hypoglycemia and severe hypoglycemia varied or were not specified in the included studies.
- In the largest study, severe hypoglycemia occurred in a similar number of patients in the sensor-augmented pump arm and the MDI/SMBG group (21 out of 247 vs. 17 out of 248; p = 0.58). In another study, there was no significant difference in the occurrence of severe hypoglycemia, with four episodes occurring in the sensor-augmented pump group and one episode occurring in the MDI/SMBG group (9% vs. 3%; p = 0.21); 19 episodes⁄100 person-years in the sensor-augmented pump group and six episodes⁄100 person-years in the MDI/SMBG group were reported. In the remaining two studies that assessed severe hypoglycemia, the number of patients experiencing severe hypoglycemia and the types of events were not specified.
- One study assessed the time spent with nonsevere hypoglycemia, while the second trial calculated the percentage of time spent with hypoglycemia and the number of nonsevere hypoglycemic events. Both studies reported no significant difference between the arms.
Abbreviations: 95% CI = 95-percent confidence interval; CSII = continuous subcutaneous insulin infusion; HbA1c = hemoglobin A1c; MDI = multiple daily injections; rt-CGM = real-time continuous glucose monitoring; SMBG = self-monitoring of blood glucose
- Golden SH, Brown T, Yeh HC, et al. Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness. Comparative Effectiveness Review No. 57 (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I). Rockville, MD: Agency for Healthcare Research and Quality; July 2012. AHRQ Publication No. 12-EHC036. Available at www.effectivehealthcare.ahrq.gov/glucose.cfm.
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