Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis
Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated wit...
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| Veröffentlicht in: | Journal of diabetes science and technology 2023-09, Vol.17 (5), p.1337-1363 |
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| container_title | Journal of diabetes science and technology |
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| creator | Fisher, Stephanie A. Huang, Jingtong DuBord, Ashley Y. Xu, Nicole Y. Beestrum, Molly Niznik, Charlotte Yeung, Andrea M. Nguyen, Kevin T. Klonoff, David C. Yee, Lynn M. |
| description | Background:
The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM.
Methods:
A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar |
| doi_str_mv | 10.1177/19322968231186626 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10563519</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_19322968231186626</sage_id><sourcerecordid>2846930012</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-8aef95e7aa14403331b24ee9091adfe9122ff98d4a648371c8f77c8af6a6df613</originalsourceid><addsrcrecordid>eNp9UctuFDEQHCEQCQsfwAX5yGXC2J6xZ7ig1YZHpEQgAlytXm978WrWXvwImn_hY_FoQxSExMnurupqu6qqntPmjFIpX9GBMzaInnFKeyGYeFCdzr16bj68dz-pnsS4a5qu7aV8XJ1w2bWMC3la_Vp5l6zLPkdyndc6J3A4FxfO5Gi9I98wxFJf5THZw4jkHOw4FXiHOhU8Em9KFfNoHTE-kE8BtxgTzCCM5NzCGhNGUuAZcuD09JosyfUUE-4LTZPPeGPxJwG3IVeYoF6WwSna-LR6ZGCM-Oz2XFRf3739svpQX358f7FaXtaaDzTVPaAZOpQAtG0bzjldsxZxaAYKG4MDZcyYod-0INqeS6p7I6XuwQgQGyMoX1RvjrqHvN7jRqNLAUZ1CHYPYVIerPobcfa72vobRZtO8K7YvKhe3ioE_yOX76u9jRrH8eimYn0rBt40lBUqPVJ18DEGNHd7aKPmWNU_sZaZF_cfeDfxJ8dCODsSImxR7XwOxcL4H8Xf4L6vHg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2846930012</pqid></control><display><type>article</type><title>Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis</title><source>Access via SAGE</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Fisher, Stephanie A. ; Huang, Jingtong ; DuBord, Ashley Y. ; Xu, Nicole Y. ; Beestrum, Molly ; Niznik, Charlotte ; Yeung, Andrea M. ; Nguyen, Kevin T. ; Klonoff, David C. ; Yee, Lynn M.</creator><creatorcontrib>Fisher, Stephanie A. ; Huang, Jingtong ; DuBord, Ashley Y. ; Xu, Nicole Y. ; Beestrum, Molly ; Niznik, Charlotte ; Yeung, Andrea M. ; Nguyen, Kevin T. ; Klonoff, David C. ; Yee, Lynn M.</creatorcontrib><description>Background:
The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM.
Methods:
A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models.
Results:
Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI.
Conclusions:
Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.</description><identifier>ISSN: 1932-2968</identifier><identifier>EISSN: 1932-2968</identifier><identifier>EISSN: 1932-3107</identifier><identifier>DOI: 10.1177/19322968231186626</identifier><identifier>PMID: 37542367</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Diabetes Mellitus, Type 1 - drug therapy ; Female ; Glycated Hemoglobin ; Humans ; Hypoglycemia - chemically induced ; Hypoglycemia - drug therapy ; Hypoglycemia - epidemiology ; Hypoglycemic Agents - therapeutic use ; Infant, Newborn ; Infusions, Subcutaneous ; Injections, Subcutaneous ; Insulin - therapeutic use ; Insulin Infusion Systems ; Insulin, Regular, Human - therapeutic use ; Pregnancy ; Pregnancy in Diabetics - drug therapy ; Premature Birth - drug therapy ; Review</subject><ispartof>Journal of diabetes science and technology, 2023-09, Vol.17 (5), p.1337-1363</ispartof><rights>2023 Diabetes Technology Society</rights><rights>2023 Diabetes Technology Society 2023 Diabetes Technology Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c391t-8aef95e7aa14403331b24ee9091adfe9122ff98d4a648371c8f77c8af6a6df613</cites><orcidid>0000-0002-1478-7065 ; 0000-0001-9353-8819 ; 0000-0001-9102-6537 ; 0000-0002-6274-0544 ; 0000-0002-5592-453X ; 0000-0002-3119-9361 ; 0000-0001-6394-6862</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563519/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563519/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,21823,27928,27929,43625,43626,53795,53797</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37542367$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fisher, Stephanie A.</creatorcontrib><creatorcontrib>Huang, Jingtong</creatorcontrib><creatorcontrib>DuBord, Ashley Y.</creatorcontrib><creatorcontrib>Xu, Nicole Y.</creatorcontrib><creatorcontrib>Beestrum, Molly</creatorcontrib><creatorcontrib>Niznik, Charlotte</creatorcontrib><creatorcontrib>Yeung, Andrea M.</creatorcontrib><creatorcontrib>Nguyen, Kevin T.</creatorcontrib><creatorcontrib>Klonoff, David C.</creatorcontrib><creatorcontrib>Yee, Lynn M.</creatorcontrib><title>Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis</title><title>Journal of diabetes science and technology</title><addtitle>J Diabetes Sci Technol</addtitle><description>Background:
The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM.
Methods:
A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models.
Results:
Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI.
Conclusions:
Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.</description><subject>Diabetes Mellitus, Type 1 - drug therapy</subject><subject>Female</subject><subject>Glycated Hemoglobin</subject><subject>Humans</subject><subject>Hypoglycemia - chemically induced</subject><subject>Hypoglycemia - drug therapy</subject><subject>Hypoglycemia - epidemiology</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Infant, Newborn</subject><subject>Infusions, Subcutaneous</subject><subject>Injections, Subcutaneous</subject><subject>Insulin - therapeutic use</subject><subject>Insulin Infusion Systems</subject><subject>Insulin, Regular, Human - therapeutic use</subject><subject>Pregnancy</subject><subject>Pregnancy in Diabetics - drug therapy</subject><subject>Premature Birth - drug therapy</subject><subject>Review</subject><issn>1932-2968</issn><issn>1932-2968</issn><issn>1932-3107</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UctuFDEQHCEQCQsfwAX5yGXC2J6xZ7ig1YZHpEQgAlytXm978WrWXvwImn_hY_FoQxSExMnurupqu6qqntPmjFIpX9GBMzaInnFKeyGYeFCdzr16bj68dz-pnsS4a5qu7aV8XJ1w2bWMC3la_Vp5l6zLPkdyndc6J3A4FxfO5Gi9I98wxFJf5THZw4jkHOw4FXiHOhU8Em9KFfNoHTE-kE8BtxgTzCCM5NzCGhNGUuAZcuD09JosyfUUE-4LTZPPeGPxJwG3IVeYoF6WwSna-LR6ZGCM-Oz2XFRf3739svpQX358f7FaXtaaDzTVPaAZOpQAtG0bzjldsxZxaAYKG4MDZcyYod-0INqeS6p7I6XuwQgQGyMoX1RvjrqHvN7jRqNLAUZ1CHYPYVIerPobcfa72vobRZtO8K7YvKhe3ioE_yOX76u9jRrH8eimYn0rBt40lBUqPVJ18DEGNHd7aKPmWNU_sZaZF_cfeDfxJ8dCODsSImxR7XwOxcL4H8Xf4L6vHg</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Fisher, Stephanie A.</creator><creator>Huang, Jingtong</creator><creator>DuBord, Ashley Y.</creator><creator>Xu, Nicole Y.</creator><creator>Beestrum, Molly</creator><creator>Niznik, Charlotte</creator><creator>Yeung, Andrea M.</creator><creator>Nguyen, Kevin T.</creator><creator>Klonoff, David C.</creator><creator>Yee, Lynn M.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1478-7065</orcidid><orcidid>https://orcid.org/0000-0001-9353-8819</orcidid><orcidid>https://orcid.org/0000-0001-9102-6537</orcidid><orcidid>https://orcid.org/0000-0002-6274-0544</orcidid><orcidid>https://orcid.org/0000-0002-5592-453X</orcidid><orcidid>https://orcid.org/0000-0002-3119-9361</orcidid><orcidid>https://orcid.org/0000-0001-6394-6862</orcidid></search><sort><creationdate>20230901</creationdate><title>Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis</title><author>Fisher, Stephanie A. ; Huang, Jingtong ; DuBord, Ashley Y. ; Xu, Nicole Y. ; Beestrum, Molly ; Niznik, Charlotte ; Yeung, Andrea M. ; Nguyen, Kevin T. ; Klonoff, David C. ; Yee, Lynn M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-8aef95e7aa14403331b24ee9091adfe9122ff98d4a648371c8f77c8af6a6df613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Diabetes Mellitus, Type 1 - drug therapy</topic><topic>Female</topic><topic>Glycated Hemoglobin</topic><topic>Humans</topic><topic>Hypoglycemia - chemically induced</topic><topic>Hypoglycemia - drug therapy</topic><topic>Hypoglycemia - epidemiology</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Infant, Newborn</topic><topic>Infusions, Subcutaneous</topic><topic>Injections, Subcutaneous</topic><topic>Insulin - therapeutic use</topic><topic>Insulin Infusion Systems</topic><topic>Insulin, Regular, Human - therapeutic use</topic><topic>Pregnancy</topic><topic>Pregnancy in Diabetics - drug therapy</topic><topic>Premature Birth - drug therapy</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fisher, Stephanie A.</creatorcontrib><creatorcontrib>Huang, Jingtong</creatorcontrib><creatorcontrib>DuBord, Ashley Y.</creatorcontrib><creatorcontrib>Xu, Nicole Y.</creatorcontrib><creatorcontrib>Beestrum, Molly</creatorcontrib><creatorcontrib>Niznik, Charlotte</creatorcontrib><creatorcontrib>Yeung, Andrea M.</creatorcontrib><creatorcontrib>Nguyen, Kevin T.</creatorcontrib><creatorcontrib>Klonoff, David C.</creatorcontrib><creatorcontrib>Yee, Lynn M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of diabetes science and technology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fisher, Stephanie A.</au><au>Huang, Jingtong</au><au>DuBord, Ashley Y.</au><au>Xu, Nicole Y.</au><au>Beestrum, Molly</au><au>Niznik, Charlotte</au><au>Yeung, Andrea M.</au><au>Nguyen, Kevin T.</au><au>Klonoff, David C.</au><au>Yee, Lynn M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis</atitle><jtitle>Journal of diabetes science and technology</jtitle><addtitle>J Diabetes Sci Technol</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>17</volume><issue>5</issue><spage>1337</spage><epage>1363</epage><pages>1337-1363</pages><issn>1932-2968</issn><eissn>1932-2968</eissn><eissn>1932-3107</eissn><abstract>Background:
The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM.
Methods:
A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models.
Results:
Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI.
Conclusions:
Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>37542367</pmid><doi>10.1177/19322968231186626</doi><tpages>27</tpages><orcidid>https://orcid.org/0000-0002-1478-7065</orcidid><orcidid>https://orcid.org/0000-0001-9353-8819</orcidid><orcidid>https://orcid.org/0000-0001-9102-6537</orcidid><orcidid>https://orcid.org/0000-0002-6274-0544</orcidid><orcidid>https://orcid.org/0000-0002-5592-453X</orcidid><orcidid>https://orcid.org/0000-0002-3119-9361</orcidid><orcidid>https://orcid.org/0000-0001-6394-6862</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Access via SAGE; MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Diabetes Mellitus, Type 1 - drug therapy Female Glycated Hemoglobin Humans Hypoglycemia - chemically induced Hypoglycemia - drug therapy Hypoglycemia - epidemiology Hypoglycemic Agents - therapeutic use Infant, Newborn Infusions, Subcutaneous Injections, Subcutaneous Insulin - therapeutic use Insulin Infusion Systems Insulin, Regular, Human - therapeutic use Pregnancy Pregnancy in Diabetics - drug therapy Premature Birth - drug therapy Review |
| title | Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis |
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