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Title: The efficacy and safety of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) in pregnant women with type 1 diabetes mellitus : systematic review and meta-analysis
Abstract:
The aim of this doctoral dissertation is the evaluation of efficacy and safety of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) in women with pre-gestational diabetes (PGDM) based on the systematic review of randomized and observational studies. Additionally, methodological issues were also considered including the impact of observational studies and conference abstracts on the results of systematic reviews. The systematic search retrieved 38 original papers, including 15 conference abstracts. The majority of studies were open label, nonrandomized controlled trials with high risk of selection bias. Overall, the studies reported on 4499 pregnancies complicated by T1DM, out of which 183 were included in RCTs. Meta-analyses of available studies has shown that the difference between CSII and MDI with respect to HbA1c was largest in the 1st trimester (WMD = -0.45% [-0.64; -0.26]) and became less pronounced over the course of pregnancy, reaching the value of WMD = -0.24% [-0.39; -0.10] and WMD = -0.11% [-0.22; -0.001] in the 2nd and the 3rd trimester, respectively. In CSII group weight gain during pregnancy was higher while daily insulin dose was lower in all 3 trimesters. No significant difference between CSII and MDI was noticed with respect to maternal complications as well as to the majority of fetal complications. The percentage of neo ; nates with birth weight large for gestational age (>90th percentile) was significantly higher in the CSII group (RR = 1.20 [1.07; 1.35]). For the majority of outcomes meta-analyses solely based on full text papers were consistent with base case analysis.
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Last modified:
Mar 16, 2023
In our library since:
Mar 16, 2023
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http://dl.cm-uj.krakow.pl:8080/publication/4979
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| Edition name | Date |
|---|---|
| ZB-126050 | Mar 16, 2023 |
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