Chapter

The evidence base for insulin pump therapy

Edited by John Pickup

in Insulin Pump Therapy and Continuous Glucose Monitoring

Published on behalf of Oxford University Press

ISBN: 9780199568604
Published online May 2011 | e-ISBN: 9780199607440 | DOI: http://dx.doi.org/10.1093/med/9780199568604.003.0002

Series: Oxford Diabetes Library

The evidence base for insulin pump therapy

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• All grades of hypoglycaemia are less during continuous subcutaneous insulin infusion (CSII) than during multiple daily insulin injections (MDI) treatment. The mean frequency of severe hypoglycaemia is about 75% less on CSII vs. MDI, with the greatest reduction occurring in those with most hypoglycaemia on MDI • Meta-analysis of randomized controlled trials (RCTs) and before/after studies shows that the mean difference in HbA1c between MDI and CSII is about 0.5%–0.6%, but the worst controlled subjects on MDI enjoy the greatest improvement on switching to CSII. Those with an HbA1c of 9%–10% on MDI may see a reduction of 3%–4% on CSII. Glycaemic variability is also improved on switching to CSII • Other benefits of CSII include a reduction in the dawn phenomenon, reduced daily insulin dosage, and improved quality of life • Health economic studies indicate that CSII is a cost-effective use of resources

Chapter.  4060 words.  Illustrated.

Subjects: Endocrinology and Diabetes

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