The aim of this review was to determine how the way of administrating insulin and monitoring glucose affects the development of type 1 and 2 diabetes mellitus.
All patients with type 1 diabetes (T1DM), and many patients with type 2 diabetes (T2DM) require daily insulin therapy. Monitoring blood glucose levels is a critical part of insulin therapy. The hemoglobin A1C (HbA1c) test is a common blood test used to gauge how well diabetes is managed. Its result reflects the patients average blood sugar level from the past two to three months.
New insulin delivery systems and glucose monitoring devices are designed to improve the control of blood glucose levels preventing side effects, such as hypoglycemia (low blood sugar levels).
Two methods are currently used for insulin delivery: continuous subcutaneous infusion (CSII) and multiple daily injections (MDI).
There are many different devices and new systems developed for monitoring blood glucose levels. Self-monitoring of blood glucose (SMBG) and real-time continuous glucose monitoring (rt-CGM) can be used with both daily injections CSII. The newest method used is a sensor-augmented pumps for insulin delivery (SAPs) who combine insulin pump with a sensor for monitoring glucose levels.
This review compared the results from 33 other studies made on children or adults. The results show that both MDI and CSII had similar effects on HbA1c levels and in severe hypoglycemia in children or adults with T1DM and adults with T2DM. In adults with T1DM, HbA1c levels decreased more with the CSII compared to MDI.
As for rt-CGM, it achieved lower HbA1c levels compared to self-monitoring, without increasing the risk for hypoglycemia in all the considered studies.
The results show that SAPs are superior to self-monitoring and MDI in both adults and children with T1DM, decreasing HbA1c levels. However, the results seemed to be similar concerning hypoglycemia.
In conclusion CSII seem to have the most favorable effect on the glycemic control in adults with T1DM. SAPs were superior to MDI and SMBG without increasing the risk of hypoglycemia.
The limitations of the article were that the reviewed studies were mostly small, of short duration, and limited to white persons with T1DM, and thus cannot be applied to general diabetes population. Also the study did not address issues as availability, costs or insurance coverage of the devices.
Published By :
Annals of internal medicine
Date :
Sep 04, 2012
