Effectiveness of Continuous Subcutaneous Insulin Infusion on Parental Quality of Life and Glycemic Control Among Children With T1D: Meta-Analysis

Background: Type 1 diabetes (T1D) is one of the most common chronic diseases in childhood. Daily diabetes management poses a major challenge for parents. Intensive insulin therapy using continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) are recommended for patients with T1D, but evidence for their effectiveness on parental quality of life (QOL) and glycemic control among children with T1D is inconclusive. Objectives: A systematic review was conducted to determine the best available evidence regarding the effectiveness of CSII compared to MDI on parental QOL and glycemic control among children with T1D. Methods: Studies in English and Chinese from 1978 to March 2015 were identified by searching electronic databases, published references, and unpublished studies. Randomized controlled trials (RCTs) comparing CSII with MDI related to parental QOL and glycemic control (HbA1c) among patients aged 18years or below with T1D were included. Secondary outcomes were episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA). Results: Seven RCTs were identified. Parental QOL was reported in two studies, with one study reporting no significant improvement in the CSII group and one reporting a significant reduction in diabetes-related worry in the CSII group but increased frequency of stress relating to child medical care in the MDI group. Meta-analysis of seven RCTs involving 220 patients demonstrated that CSII was associated with significant decrease in HbA1c level (MD=-0.24%, 95% CI=-0.41 to -0.07, p=.006) compared to MDI. There were no significant differences in episodes of SH and DKA between the CSII and MDI groups. Linking Evidence to Action: CSII slightly reduced HbA1c by .24% compared to MDI. Based on two RCTs with small sample sizes, there is insufficient evidence to draw any conclusions on the beneficial effects of CSII compared with MDI on parental QOL among children with T1D. More RCTs with larger samples are needed.