More comparative effectiveness research needed for diabetes treatments
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Researchers, led by Hsin-Chieh Yeh, PhD, of John Hopkins University in Baltimore, conducted a meta analysis of comparative effectiveness studies for the two treatments and for two methods of monitoring--self-monitoring of blood glucose (SMBG) and real-time continuous glucose monitoring (rt-CGM). The results were published in the Sept. 4 issue of the Annals of Internal Medicine.
“Although these technologies are widely used, their effectiveness has not been consistently demonstrated and the populations most likely to benefit are unclear,” Yeh et al wrote. “Health professionals and their diabetic patients need objective information when making decisions about these technologies, which may be expensive or heavily marketed. Such information is important to persons who decide on reimbursement policies and to companies developing new treatments and devices.”
Researchers searched for original studies published between 1966 and February 2012 in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov to include in their review. Their search returned 33 studies in 37 articles, including 24 parallel randomized control trials and nine randomized crossover trials.
CSII and MDI have similar effects on glycemic control and the incidence of severe hypoglycemia in children and adults with type 1 and type 2 diabetes, indicating that the approach to intensive insulin therapy can be individualized according to patient preference, researchers determined.
In terms of monitoring methods, researchers concluded that rt-CGM achieved better glycemic control than SMBG, but not at a threshold they determined to be clinically meaningful and mixed modes of insulin therapy in the studies prevented them from comparing rt-CGM versus SMB in patients using only CSII or MDI.
There were a number of limitations to the review, researchers noted. The largest study considered had only 322 participants and the longest follow-up among the studies was 52 weeks. In addition, researchers did not consider availability, cost or insurance coverage and younger, older and minority patients were underrepresented in the studies included for review.
“Future research should include larger studies in populations in which diabetes is increasing--elderly persons, persons with insulin-requiring type 2 diabetes and minority populations,” Yeh and colleagues concluded. “Studies should report on important clinical outcomes, consider effects of adherence on outcomes and assess cost-effectiveness.”