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2016 ; 10
(6
): 1388-1398
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Do We Need Updated Guidelines on the Use of Insulin Pump Therapy in Type 2
Diabetes? A Review of National and International Practice Guidelines
#MMPMID27621141
Cohen O
; Valentine W
J Diabetes Sci Technol
2016[Nov]; 10
(6
): 1388-1398
PMID27621141
show ga
BACKGROUND: Continuous subcutaneous insulin infusion (CSII) is used less for type
2 than for type 1 diabetes because of inconsistencies in evidence of
effectiveness. We reviewed published guidelines on intensive insulin therapy in
type 2 diabetes to assess whether updating of guidance is needed with respect to
evidence used and recommendations for CSII in diabetes management. METHODS: A
literature review was performed to identify published national and international
guidelines on type 2 diabetes management. Searches were performed using PubMed,
Cochrane Library, and Embase databases, and websites of national health care
agencies, reimbursement agencies, and professional associations. Searches were
limited to articles published in English between 2004 and 2014 and 1666 unique
hits were identified, of which 22 were reviewed following screening. RESULTS:
Only 6 of the 22 guidelines identified from North and South America, Western
Europe, Greece, and Israel provided specific recommendations on intensive insulin
therapy and the role of CSII, and only 1 provided information on the grade of
evidence supporting recommendations. Quality appraisal based on the AGREE II tool
suggested that published guidelines may have limitations in terms of search
methodology and evidence grading, and findings were of mixed rigor and clarity.
Only 3 guidelines described the population for whom CSII may be appropriate.
CONCLUSIONS: Guidelines need to improve the evidence base, rigor, clarity, and
grading of evidence associated with recommendations on intensive insulin therapy
in type 2 diabetes. Future updates may benefit from considering recent evidence
on the efficacy of CSII in poorly controlled patients on MDI.