Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections for Glycemic Control in Pediatric Patients...

Area of Science:

• Endocrinology
• Metabolic Disorders
• Pediatric Diabetes Management

Background:

• Type 1 diabetes mellitus (T1DM) in children requires effective glucose management.
• Multiple daily injections (MDIs) and continuous subcutaneous insulin infusion (CSII) are primary treatment modalities.
• Comparing their efficacy and safety is crucial for optimizing pediatric T1DM care.

Purpose of the Study:

• To systematically review and meta-analyze studies comparing glycemic control and metabolic outcomes between CSII and MDI in pediatric T1DM.
• To assess differences in HbA1c, insulin dosage, adverse events, and other relevant clinical parameters.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Web of Science, Scopus, etc.) in February 2025.
• Systematic review and meta-analysis were conducted following PRISMA guidelines.
• Eighteen randomized controlled trials involving 1229 pediatric participants were analyzed.

Main Results:

• CSII significantly reduced HbA1c levels compared to MDI (MD = -0.37%).
• CSII was associated with a significant increase in adverse events (RR = 1.45) and body mass index (MD = 0.43).
• No significant differences were observed in severe hypoglycemia, diabetic ketoacidosis, or insulin requirements.

Conclusions:

• CSII demonstrates superior efficacy in reducing HbA1c in pediatric T1DM patients compared to MDI.
• Evidence regarding optimal insulin requirements remains inconclusive, suggesting a need for larger, well-designed trials.
• Personalized treatment strategies considering patient preferences and accessibility are essential for T1DM management.