Type 1 diabetes: insulin treatment – Related resources

Cochrane reviews

• There appear to be no significant differences in metabolic control or hypoglycaemic episodes between various insulin species. Patient-centred outcomes like patient satisfaction, health-related quality of life, and diabetes-related morbidity have not been studied . Inhaled insulin taken before meals, in conjunction with an injected basal insulin, is effective in maintaining glycaemic control .
• Out-patient/home management of type 1 diabetes in children at diagnosis may not lead to any disadvantages in terms of metabolic control, acute complications and hospitalisations, psychosocial variables, or total costs .
• Long acting insulin preparations appear to be superior in their nocturnal effect causing fewer episodes of nocturnal hypoglycaemia and resulting in a lower fasting glucose level than NPH insulin but their effect on glycosylated haemoglobin is clinically unremarkable. Their potential long-term adverse effects are unknown .
• Short acting insulin analogues may provide a slightly better long-term glycaemic control as compared with regular human insulin in diabetic patients. Long-term efficacy and safety data are not available .
• Addition of metformin to insulin therapy seems to improve metabolic control in poorly controlled adolescents with type 1 diabetes, although the evidence is insufficient. Long-term effects on metabolic control, effects on health-related quality of life, morbidity and mortality are not known .
• Continuous insulin infusion treatment may modestly improve glycated hemoglobin levels and health-related quality of life in people with type 1 diabetes compared with conventional insulin therapy (multiple injections per day).
• Intensive glycaemic control is effective in reducing the progression of nephropathy in people with type 1 diabetes.
• During pregnancy, loose glycaemic control (fasting blood glucose 6.7 to 8.9 mmol/L) might possibly increase pre-eclampsia, caesarean sections, and macrosomia compared with tight-moderate glycaemic control (fasting blood glucose under or 6.7 mmol/L) in women with type 1 diabetes, although the data are insufficient .

Other evidence summaries

• Shared care for diabetes in certain circumstances seems to be as effective as hospital care, although the evidence is insufficient .
• Continuous subcutaneous infusion of insulin with portable pump appears to be effective in achieving good outcomes in type 1 diabetic patients but the effect is comparable to intensive schedules with multiple injections .

Literature