Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections for Glycemic Control in Pediatric Patients With Type 1 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis

Résumé fourni par la source

Objective To compare glycemic control and metabolic outcomes between multiple daily injections (MDIs) and continuous subcutaneous insulin infusion (CSII) in pediatric type 1 diabetes mellitus. Methods Searches were conducted in PubMed MEDLINE, Web of Science, Scopus, CNKI, CINAHL, Cochrane, and EMBASE on 02/2025. A systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes included HbA1c levels, total daily dose, diabetic ketoacidosis, hypoglycemia events, body mass index change, and adverse events. Statistical analysis was performed using R version 3.4.3. Results Eighteen randomized controlled trials (1229 participants) were analyzed. CSII compared to MDI significantly reduced HbA1c (MD = −0.37%; 95% CI: −0.62 to −0.12; P < 0.01; I2=86.6%), adverse events (relative risk [RR]: 1.45; 95% CI: 1.10 to 1.90; P < 0.01; I2=0.0%), and increased body mass index (MD = 0.43; 95% CI: 0.31 to 0.55; P < 0.01; I2=0.0%). No significant differences were found for insulin requirement (MD = −0.08 U/kg/d; P = 0.14), severe hypoglycemia (RR = 1.09; P = 0.73), or diabetic ketoacidosis (RR = 1.40; P = 0.43). Trial sequential analysis for HbA1c reduction indicated conclusive evidence, while for insulin requirements, it remains inconclusive due to insufficient sample size. Conclusion Our meta-analysis confirms CSII achieves superior HbA1c reduction versus MDI in pediatric type 1 diabetes, as supported by trial sequential analysis. However, evidence for insulin requirements remains inconclusive, highlighting the need for larger trials and personalized treatment considering patient preferences and accessibility.

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