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Effectiveness of Continuous Subcutaneous Insulin Infusion on Parental Quality of Life and Glycemic Control Among
Anita Yuk-Ling Li1, Winnie Kwok-Wei So2, Doris Yin-Ping Leung2
1North District Hospital, Fanling, N.T, Hong Kong.
Insights
Continuous subcutaneous insulin infusion (CSII) slightly reduced HbA1c in children with type 1 diabetes (T1D) compared to multiple daily injections (MDI). Evidence on parental quality of life remains inconclusive, requiring further research.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Clinical Research
Background:
- Type 1 diabetes (T1D) is a prevalent childhood chronic condition.
- Intensive insulin therapies, including continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), are standard for T1D management.
- The impact of these therapies on parental quality of life (QOL) and pediatric glycemic control requires further clarification.
Purpose of the Study:
- To systematically review and synthesize evidence comparing the effectiveness of CSII versus MDI in children with T1D.
- To evaluate the impact on parental QOL and glycemic control (HbA1c).
- To assess secondary outcomes including severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) episodes.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) published in English and Chinese from 1978 to March 2015.
- Included studies focused on patients aged 18 years or younger with T1D, comparing CSII and MDI.
- Data extraction included parental QOL, HbA1c, SH, and DKA.
Main Results:
- Seven RCTs involving 220 patients were analyzed.
- CSII demonstrated a statistically significant reduction in HbA1c levels (mean difference = -0.24%) compared to MDI (p = .006).
- No significant differences were observed in SH or DKA episodes between CSII and MDI groups. Parental QOL data were limited and inconclusive.
Conclusions:
- CSII offers a slight but significant improvement in glycemic control (HbA1c) for children with T1D compared to MDI.
- Current evidence is insufficient to determine the effects of CSII versus MDI on parental QOL due to small sample sizes in available studies.
- Larger, robust RCTs are necessary to elucidate the impact on parental QOL and confirm glycemic control benefits.
Background:
Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood. Daily diabetes management poses a major challenge for parents. Intensive insulin therapy using continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) are recommended for patients with T1D, but evidence for their effectiveness on parental quality of life (QOL) and glycemic control among children with T1D is inconclusive.
Objectives:
A systematic review was conducted to determine the best available evidence regarding the effectiveness of CSII compared to MDI on parental QOL and glycemic control among children with T1D.
Methods:
Studies in English and Chinese from 1978 to March 2015 were identified by searching electronic databases, published references, and unpublished studies. Randomized controlled trials (RCTs) comparing CSII with MDI related to parental QOL and glycemic control (HbA1c) among patients aged 18 years or below with T1D were included. Secondary outcomes were episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA).
Results:
Seven RCTs were identified. Parental QOL was reported in two studies, with one study reporting no significant improvement in the CSII group and one reporting a significant reduction in diabetes-related worry in the CSII group but increased frequency of stress relating to child medical care in the MDI group. Meta-analysis of seven RCTs involving 220 patients demonstrated that CSII was associated with significant decrease in HbA1c level (MD = -0.24%, 95% CI = -0.41 to -0.07, p = .006) compared to MDI. There were no significant differences in episodes of SH and DKA between the CSII and MDI groups.
Linking Evidence To Action:
CSII slightly reduced HbA1c by .24% compared to MDI. Based on two RCTs with small sample sizes, there is insufficient evidence to draw any conclusions on the beneficial effects of CSII compared with MDI on parental QOL among children with T1D. More RCTs with larger samples are needed.
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