Glycemic Control during Continuous Subcutaneous Insulin Infusion Therapy Versus Multiple Daily Insulin Injections in Pediatric Patients with Type1 Diabetes Mellitus: Meta-analysis Study

Abstract

Type 1 diabetes is characterized by autoimmune destruction of pancreatic islet cells that results in an inability to produce insulin and a need for daily insulin administration to sustain life. Individuals with type 1 diabetes require insulin that can be administered using a range of insulin types (e.g., rapid, short, intermediate, and long-acting) and delivery methods [e.g., subcutaneous injection, continuous subcutaneous insulin infusion (CSII)] to prevent life threatening ketosis, to maintain normoglycemia without inducing significant hypoglycemia, to maintain normal body weight and promote normal growth and development in children. Tight glycemic control with intensive insulin therapy reduces the risk of the microvascular and macrovascular complications of diabetes, while resulting hypoglycemic episodes can be a source of significant distress and anxiety to patients and a barrier to achieving tight glycemic control. This difficulty led to the development of more physiological basal and mealtime (prandial) insulins that, when used together, mimic normal pancreatic function, In addition, the development of continuous subcutaneous insulin infusion (CSII) via a pump provided another means to deliver insulin in a more physiological manner. Thus today, patients receive intensive insulin therapy as three or more daily insulin injections (i.e., multiple daily injections [MDI]) or by the use of the external CSII.