AACE endocrinology and diabetes · 2025
Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections for Glycemic Control in Pediatric Patients With Type 1 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.
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Calderon Martinez Ernesto, Saji Stephin Zachariah, Sámano Sánchez Michelle, Nieto Maigualida, Hammoud Ahmad, De la Rosa-Valdez España, Briceno Silva Gabriela, Arruarana Victor Sebastian, Newman Molina Andrea, Sanchez Cruz Camila, Noreña Jairo Arturo, Correa Marquez Ricardo
Аннотация
OBJECTIVE: To compare glycemic control and metabolic outcomes between multiple daily injections (MDIs) and continuous subcutaneous insulin infusion (CSII) in pediatric type 1 diabetes mellitus.
METHODS: Searches were conducted in PubMed MEDLINE, Web of Science, Scopus, CNKI, CINAHL, Cochrane, and EMBASE on 02/2025. A systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes included HbA1c levels, total daily dose, diabetic ketoacidosis, hypoglycemia events, body mass index change, and adverse events. Statistical analysis was performed using R version 3.4.3.
RESULTS: Eighteen randomized controlled trials (1229 participants) were analyzed. CSII compared to MDI significantly reduced HbA1c (MD = -0.37%; 95% CI: -0.62 to -0.12; P < 0.01; I2 = 86.6%), adverse events (relative risk [RR]: 1.45; 95% CI: 1.10 to 1.90; P < 0.01; I2 = 0.0%), and increased body mass index (MD = 0.43; 95% CI: 0.31 to 0.55; P < 0.01; I2 = 0.0%). No significant differences were found for insulin requirement (MD = -0.08 U/kg/d; P = 0.14), severe hypoglycemia (RR = 1.09; P = 0.73), or diabetic ketoacidosis (RR = 1.40; P = 0.43). Trial sequential analysis for HbA1c reduction indicated conclusive evidence, while for insulin requirements, it remains inconclusive due to insufficient sample size.
CONCLUSION: Our meta-analysis confirms CSII achieves superior HbA1c reduction versus MDI in pediatric type 1 diabetes, as supported by trial sequential analysis. However, evidence for insulin requirements remains inconclusive, highlighting the need for larger trials and personalized treatment considering patient preferences and accessibility.
METHODS: Searches were conducted in PubMed MEDLINE, Web of Science, Scopus, CNKI, CINAHL, Cochrane, and EMBASE on 02/2025. A systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes included HbA1c levels, total daily dose, diabetic ketoacidosis, hypoglycemia events, body mass index change, and adverse events. Statistical analysis was performed using R version 3.4.3.
RESULTS: Eighteen randomized controlled trials (1229 participants) were analyzed. CSII compared to MDI significantly reduced HbA1c (MD = -0.37%; 95% CI: -0.62 to -0.12; P < 0.01; I2 = 86.6%), adverse events (relative risk [RR]: 1.45; 95% CI: 1.10 to 1.90; P < 0.01; I2 = 0.0%), and increased body mass index (MD = 0.43; 95% CI: 0.31 to 0.55; P < 0.01; I2 = 0.0%). No significant differences were found for insulin requirement (MD = -0.08 U/kg/d; P = 0.14), severe hypoglycemia (RR = 1.09; P = 0.73), or diabetic ketoacidosis (RR = 1.40; P = 0.43). Trial sequential analysis for HbA1c reduction indicated conclusive evidence, while for insulin requirements, it remains inconclusive due to insufficient sample size.
CONCLUSION: Our meta-analysis confirms CSII achieves superior HbA1c reduction versus MDI in pediatric type 1 diabetes, as supported by trial sequential analysis. However, evidence for insulin requirements remains inconclusive, highlighting the need for larger trials and personalized treatment considering patient preferences and accessibility.