Continuous subcutaneous insulin infusion vs intensive conventional insulin therapy in pregnant diabetic women: a systematic review and metaanalysis of randomized, controlled trials

• Published in: American journal of obstetrics and gynecology 2007-11, Vol.197 (5), p.447-456
• Main Authors: Mukhopadhyay, Asima, MD, Farrell, Tom, MD, MRCOG, Fraser, Robert B., MD, FRCOG, Ola, Bolarinde, MRCOG, MD
• Format: Article
• Language: English
• Subjects: Administration, Cutaneous; Adult; Biological and medical sciences; diabetes mellitus; Diabetes. Impaired glucose tolerance; Diabetic Ketoacidosis - epidemiology; Diabetic Retinopathy - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A; Gynecology. Andrology. Obstetrics; Humans; Hypoglycemia; Hypoglycemic Agents - administration & dosage; Infusion Pumps, Implantable; Insulin - administration & dosage; Insulin Infusion Systems; insulin pump; Medical sciences; metaanalysis; Obstetrics and Gynecology; Odds Ratio; Pregnancy; Pregnancy in Diabetics - drug therapy; Pregnancy Outcome; Pregnancy Trimester, Third; randomized controlled trials; Randomized Controlled Trials as Topic
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.03.062

The objective of the study was to study the effects of continuous subcutaneous insulin infusion (CSII) vs multiple-dose insulin (MDI) therapy on glycemic control and pregnancy outcome in diabetic women. Randomized, controlled trials comparing CSII vs MDI in pregnant diabetic women were included after an electronic database search. Studies were rated for quality independently by 2 reviewers in accordance with the Quality of Reporting of Metaanalyses statement. Summary weighted mean difference and odds ratio were estimated for insulin dose, birthweight, gestational age, mode of delivery, hypoglycemic/ketotic episodes, worsening retinopathy, neonatal hypoglycemia, and rates of intrauterine fetal death. Six randomized clinical trials met the inclusion criteria. Pregnancy outcomes and glycemic control were not significantly different among treatment groups. Higher number of ketoacidotic episodes and diabetic retinopathy found in the CSII group did not reach statistical significance. This systematic review does not show any advantage or disadvantage of using CSII over MDI in pregnant diabetic women. Large multicenter, randomized, controlled trials addressing the quality of life/cost effectiveness are required.