Excerpt

Our recent systematic review examined specific questions about the comparative effectiveness of insulin delivery and glucose monitoring methods. The review found that intensive insulin therapy delivered either by continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) is equally effective in lowering glycated hemoglobin (HbA1c) levels in adolescents and adults with type 1 diabetes. Intensive insulin therapy delivered by both methods resulted in similar rates of severe hypoglycemia for adolescents and adults with type 1 diabetes. The review also found evidence that real-time continuous glucose monitoring (rt-CGM) is superior to self-monitoring of blood glucose (SMBG) in lowering HbA1c, without altering the risk balance of severe hypoglycemia, particularly among those who are compliant with wearing the monitoring device. Even though CSII and MDI without rt-CGM have similar effects on HbA1c, the addition of rt-CGM to CSII is superior to MDI/SMBG in lowering HbA1c. Thus, the addition of this monitoring method to SMBG and intensive insulin therapy can assist in achieving glycemic targets in individuals with type 1 diabetes. However, the review also identified several important gaps in the evidence. The objective of this report is to prioritize the needs for research addressing those gaps in the existing literature on management of insulin-requiring diabetes by engaging expert stakeholders using a modified Delphi method.

Contents

• Addendum
• Preface
• Acknowledgments
• Contributors
• Executive Summary
• Background
  • Context
  • Identification of Evidence Gaps
• Methods
  • Research Gap Identification
  • Criteria for Prioritization
  • Engagement of Stakeholders, Researchers, and Funders
  • Research Question Development and Research Design Considerations
• Results
  • Research Needs
  • Research Questions
• Discussion
• Conclusion
• References
• Acronyms and Abbreviations
• Appendix A Search Strategies for Ongoing Studies
• Appendix B Potentially Relevant Ongoing/Recently Completed Studies

Addendum added June 2013

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10061-I, Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD

Suggested citation:

Yeh H-C, Lau BD, Golden SH, Donner T, Brown TT, Bass EB. Insulin Delivery and Glucose Monitoring Methods: Future Research Needs. Future Research Needs Paper No.32. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I.) AHRQ Publication No. 13-EHC037-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2013. Addendum added June 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

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