Continuous subcutaneous insulin infusion versus multiple daily injections for type 1 diabetes

Abstract

To review the literature on continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) to help the family of a 13-year-old girl with type 1 diabetes mellitus on MDI choose the best insulin delivery method for her to improve her glycaemic control. A literature search was performed to assess available evidence regarding CSII use versus MDI use for glycaemic control. We identified 15 relevant articles and present these, with a detailed analysis of a multicentre randomised controlled trial by Mueller-Godeffroy et al. Although CSII use demonstrated a reduction in HbA_1c (-0.18 to -0.7%) in some studies compared to MDI, this finding was not consistent across all studies. Mueller-Godeffroy et al. did not find a statistically significant different in HbA_1c between CSII and MDI patients; however, additional benefits of insulin pump therapy, including improved diabetes-related quality of life and reduced care giver burden, were reported. Further high-quality randomised controlled trials and long-term data are required to assess the benefits of CSII over MDI and the longevity of these methods.

Keywords: continuous subcutaneous insulin infusion; glycaemic control; insulin pump; multiple daily injection; type 1 diabetes.