29 JUL 2012

Advances in intensive insulin therapy and glucose monitoring are designed to improve glycemic control and quality of life while limiting adverse effects such as hypoglycemia and weight gain. Currently, there are several therapies being heavily marketed to patients, but there is little objective evidence available to guide decision making about which therapy is best for the individual patient. Researchers reviewed published studies to evaluate how intensive insulin therapy (multiple daily injections versus insulin pump) or mode of blood glucose monitoring (self-monitoring versus real-time monitoring) affects outcomes in children and adults with type 1 or 2 diabetes. The researchers found that insulin pump and multiple-daily injections have similar effects on glycemic control and the incidence of severe hypoglycemia in children and adolescents with type 1 diabetes and in adults with type 2 diabetes. However, insulin pump yielded better satisfaction with diabetes treatment in children with type 1 diabetes, and better diabetes-specific quality-of-life in adults with type 1 diabetes. As for blood-glucose monitoring, real-time monitoring achieved a lower blood glucose level compared to self-monitoring. The researchers also found that real-time glucose monitoring was associated with a lower blood glucose level compared with multiple daily injection in individuals 18 years of age or younger, but the rate of severe hypoglycemia, weight gain, and quality of life did not seem to differ between intervention groups. Patients that used a sensor-augmented pump experienced greater reduction in blood glucose compared to multiple daily injection/self-monitoring use in individuals with type 1 diabetes. The researchers conclude that based on the evidence, physicians can use patient preference to guide treatment decisions for type 1 and type 2 diabetes

Annals of Internal Medicine tip sheet for July 10, 2012, online issue