Abstract
We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 237-249 |
| Number of pages | 13 |
| Journal | Journal of Women's Health |
| Volume | 24 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2015 |
Fingerprint
ASJC Scopus subject areas
- Medicine(all)
Cite this
Comparative Effectiveness of Continuous Subcutaneous Insulin Infusion Using Insulin Analogs and Multiple Daily Injections in Pregnant Women with Diabetes Mellitus : A Systematic Review and Meta-Analysis. / Ranasinghe, Padmini; Maruthur, Nisa; Nicholson, Wanda K.; Yeh, Hsin Chieh; Brown, Todd T; Suh, Yong; Wilson, Lisa; Nannes, Elisabeth B.; Berger, Zackary; Bass, Eric B; Golden, Sherita Hill.
In: Journal of Women's Health, Vol. 24, No. 3, 01.03.2015, p. 237-249.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparative Effectiveness of Continuous Subcutaneous Insulin Infusion Using Insulin Analogs and Multiple Daily Injections in Pregnant Women with Diabetes Mellitus
T2 - A Systematic Review and Meta-Analysis
AU - Ranasinghe, Padmini
AU - Maruthur, Nisa
AU - Nicholson, Wanda K.
AU - Yeh, Hsin Chieh
AU - Brown, Todd T
AU - Suh, Yong
AU - Wilson, Lisa
AU - Nannes, Elisabeth B.
AU - Berger, Zackary
AU - Bass, Eric B
AU - Golden, Sherita Hill
PY - 2015/3/1
Y1 - 2015/3/1
N2 - We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
AB - We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
UR - http://www.scopus.com/inward/record.url?scp=84924693795&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84924693795&partnerID=8YFLogxK
U2 - 10.1089/jwh.2014.4939
DO - 10.1089/jwh.2014.4939
M3 - Article
C2 - 25713996
AN - SCOPUS:84924693795
VL - 24
SP - 237
EP - 249
JO - Journal of Women's Health
JF - Journal of Women's Health
SN - 1540-9996
IS - 3
ER -