Pumps or Injections- Insulin pumps not superior to injections in diabetes control: BMJ
UK: More expensive insulin pumps are not superior to comparatively cheaper multiple daily injections (MDI) in controlling type 1 diabetes, according to a recent study.
The study, published in the journal BMJ found that no clinical benefit of subcutaneous insulin infusion (CSII) over MDI was identified in children and young people. They both delivered similar glycemic control and safety profiles when allocated at the point of type 1 diabetes diagnosis alongside education and support.
Joanne C Blair, Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK, and colleagues compared the efficacy, safety, and cost-utility of CSII with MDI regimens during the first year following diagnosis of type 1 diabetes in children and young people.
The study involved patients aged between 7 months and 15 years, with a new diagnosis of type 1 diabetes. Participants were randomized, stratified by age and treating center, to start treatment with CSII or MDI within 14 days of diagnosis. Starting doses of aspart (CSII and MDI) and glargine or detemir (MDI) were calculated according to weight and age, and titrated according to blood glucose measurements and according to local clinical practice.
The primary outcome was glycaemic control (as measured by glycated hemoglobin; HbA1c) at 12 months.
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- 294 participants were randomized and 293 included in intention to treat analyses (CSI, n=144; MDI, n=149).
- At 12 months, mean HbA1c was comparable with clinically unimportant differences between CSII and MDI participants (60.9 mmol/mol v 58.5 mmol/mol, mean difference 2.4 mmol/mol (95% confidence interval −0.4 to 5.3), P=0.09).
- Achievement of HbA1c lower than 58 mmol/mol was low among the two groups (66/143 (46%) CSII participants v 78/142 (55%) MDI participants; relative risk 0.84 (95% confidence interval 0.67 to 1.06)).
- The incidence of severe hypoglycemia and diabetic ketoacidosis were low in both groups. Fifty-four non-serious and 14 serious adverse events were reported during CSII treatment, and 17 non-serious and eight serious adverse events during MDI treatment.
- Parents (but not children) reported superior PedsQL scores for those patients treated with CSII compared to those treated with MDI.
- CSII was more expensive than MDI by £1863 (€2179; $2474; 95% confidence interval £1620 to £2137) per patient, with no additional QALY gains (difference −0.006 (95% confidence interval −0.031 to 0.018)).
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"In this randomized controlled trial of pediatric patients with a new diagnosis of type 1 diabetes, CSII treatment was neither more clinically effective nor more cost-effective than MDI, by the standards of the NHS, write the authors.
For detailed study follow the link: https://doi.org/10.1136/bmj.l1226