Effectiveness and equity of continuous subcutaneous insulin infusions in pediatric type 1 diabetes: A systematic review and meta-analysis of the literature

• Published in: Diabetes research and clinical practice Vol. 172; p. 108643
• Main Authors: Dos Santos, Tiago Jeronimo, Donado Campos, Juan de Mata, Argente, Jesús, Rodríguez-Artalejo, Fernando
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2021
• Subjects: Continuous subcutaneous insulin infusion; Diabetes Mellitus, Type 1 - drug therapy; Female; Health equity; Humans; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Insulin Infusion Systems - standards; Insulin therapy; Male; Multiple-daily injection; Pediatric type 1 diabetes; Quality of Life - psychology; Multiple-daily injection; Health equity; Insulin therapy; Pediatric type 1 diabetes; Continuous subcutaneous insulin infusion
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2020.108643

•Use of CSII modestly lowered HbA1c in randomized and in non-randomized studies.•Most of the existing literature corresponded to high-income countries.•Data available on socially disadvantaged groups suggest they would benefit from CSII.•Use of CSII seems to be mostly based on patients’ or family’s preference. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) and non-randomized studies (NRS) to assess the effectiveness and equity of continuous subcutaneous insulin infusions (CSII) versus multiple-daily injections (MDI) on glycemic outcomes. Searches were conducted between 2000 and 2019 in MEDLINE, CENTRAL, EMBASE and HTA. Included studies compared the CSII vs MDI in children and young people (CYP) ≤ 20 years with type 1 diabetes. Two independent reviewers screened the articles, extracted the data, assessed the risk of bias, evaluated the quality of evidence, and identified equity data. Results were pooled with a random-effects model. Of the 578 articles screened, 16 RCT (545 CYP on CSII) and 70 NRS (73253 on CSII) were included in the meta-analysis. There was moderate-level evidence that the CSII lower HbA1c in RCT (pooled mean difference [MD]: −0.22%; 95% confidence interval [CI]: −0.33, −0.11%; I2:34%) and insufficient in NRS (pooled MD: −0.45%; 95%CI: −0.52, −0.38%; I2:99%). The pooled incidence rate ratio of severe hypoglycemia on CSII vs MDI in RCT was 0.87 (95%CI: 0.55, 1.37; I2:0%; low-level evidence), and 0.71 (95%CI: 0.63, 0.81; I2:57%, insufficient evidence) in NRS. Health-related quality of life presented insufficient evidence. Equity data were scarcely reported. CSII modestly lower HbA1c when compared with MDI. Current literature does not provide adequate data on other glycemic outcomes. Future assessment on diabetes technology should include individual and area-level socioeconomic data. The study protocol was pre-registered in PROSPERO (CRD42018116474).