The efficacy of automated insulin delivery systems in children and adolescents with type 1 diabetes Mellitus: A systematic review and meta-analysis of randomized controlled trials

被引:19
作者
Michou, Panagiota [1 ,2 ]
Gkiourtzis, Nikolaos [3 ]
Christoforidis, Athanasios [4 ]
Kotanidou, Eleni P. [1 ,5 ]
Galli-Tsinopoulou, Asimina [1 ,5 ]
机构
[1] Aristotle Univ Thessaloniki, Fac Hlth Sci, Sch Med, Program Postgrad Studies Adolescent Med & Adolesce, Thessaloniki 54124, Greece
[2] Gennimatas Gen Hosp Thessaloniki, Dept Pediat, Thessaloniki 54635, Greece
[3] Aristotle Univ Thessaloniki, Papageorgiou Gen Hosp, Fac Hlth Sci, Sch Med,Dept Pediat 4, Thessaloniki 56429, Greece
[4] Aristotle Univ Thessaloniki, Ippokrateio Gen Hosp, Fac Hlth Sci, Sch Med,Dept Pediat 1, Thessaloniki 54643, Greece
[5] Aristotle Univ Thessaloniki, AHEPA Univ Gen Hosp, Fac Hlth Sci, Sch Med,Dept Pediat 2, Thessaloniki 54636, Greece
关键词
Artificial pancreas; Automated insulin delivery system; Insulin; Type 1 diabetes mellitus; Diabetes; Children; CLOSED-LOOP CONTROL; OVERNIGHT GLUCOSE CONTROL; ARTIFICIAL PANCREAS; GLYCEMIC CONTROL; BIONIC PANCREAS; CROSSOVER TRIAL; YOUNG-CHILDREN; PUMP THERAPY; EXERCISE; PEOPLE;
D O I
10.1016/j.diabres.2023.110678
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: Insulin administration is the treatment of choice for people with type 1 diabetes mellitus (T1D). Technological advances have led to the development of automated insulin delivery (AID) systems, aiming to optimize the quality of life of patients with T1D. We present a systematic review and meta-analysis of the current literature about the efficacy of AID systems in children and adolescents with T1D. Methods: We conducted a systematic literature search for randomized controlled trials (RCTs) until August 8th, 2022, investigating the efficacy of AID systems in the management of patients < 21 years of age with T1D. A priori subgroup and sensitivity analyses based on different settings (free-living settings, type of AID system, parallel group or crossover design) were also conducted. Results: In total, 26 RCTs reporting a total of 915 children and adolescents with T1D were included in the metaanalysis. AID systems revealed statistically significant differences in the main outcomes, such as the proportion of time in the target glucose range (3.9-10 mmol/L) (p < 0.00001), in hypoglycemia (<3.9 mmol/L) (p = 0.003) and mean proportion of HbA1C (p = 0.0007) compared to control group. Conclusions: According to the present meta-analysis, AID systems are superior to insulin pump therapy, sensoraugmented pumps and multiple daily insulin injections. Most of the included studies have a high risk of bias because of allocation, blinding of patients and blinding of assessment. Our sensitivity analyses showed that patients < 21 years of age with T1D can use AID systems, after proper education, following their daily activities. Further RCTs examining the effect of AID systems on nocturnal hypoglycemia, under free-living settings and studies examining the effect of dual-hormone AID systems are pending.
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页数:9
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