Some evidence that continuous subcutaneous insulin infusion for type I diabetes improves glycaemic control compared with multiple daily injections, but few trials have compared CSII with MDI using newer insulin analogues
- Diabetes and Endocrinology Center of Suffolk, East Patchogue, New York, USA
- Correspondence to Phyllis Wolff-McDonagh
Diabetes and Endocrinology Center of Suffolk, 285 Sills Road, East Patchogue, NY 11772 USA;
This report by Cummins and colleagues is an extensive, rigorous literature review from 2002 to 2007 examining the clinical efficacy and cost-effectiveness of continuous subcutaneous insulin infusion therapy (CSII) in diabetes. Databases searched included MEDLINE, EMBASE, The Cochrane Library, the Science Citation Index for meeting abstracts and the American Diabetes Association website. More than 900 studies were found; more than 550 were eliminated after abstract review and another 291 after full text review. A total of 74 studies were analysed, including 48 observational studies, 16 randomised controlled trials (RCTs), 4 with CSII in pregnancy and 4 systematic reviews.
The incidence and pathophysiology of type I and type II diabetes were discussed, as were quality of life issues and severe hypoglycaemia. Diabetic complications of retinopathy, neuropathy and nephropathy − the leading causes of blindness, amputation and kidney …