Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials

Pediatr Diabetes. 2009 Feb;10(1):52-8. doi: 10.1111/j.1399-5448.2008.00440.x. Epub 2008 Aug 27.


Objective: To investigate potential effects of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) on glycemic control in children with type 1 diabetes mellitus (T1DM).

Study design: Meta-analysis and systematic review of randomized control studies (RCTs). The electronic databases MEDLINE, Cochrane Library, and EMBASE were searched through October 2007.

Results: Six RCTs involving 165 participants with T1DM met our predefined inclusion criteria. Combined data from all trials showed that the CSII group compared with the MDI group experienced a significant reduction in the level of glycosylated hemoglobin. The pooled weighted mean difference (WMD) was -0.24% [95% confidence interval (95% CI) -0.41 to -0.07, p < 0.001] with a fixed model and remained significant in the random effect model. This effect was reached by slightly decreasing insulin requirement [three RCTs, n = 74, WMD -0.22 IU/kg/d (95% CI -0.31 to -0.14, p < 0.001)]. No differences in the incidences of ketoacidosis and severe hypoglycemic events were found.

Conclusions: In short-term insulin therapy, CSII compared with MDI is a more effective form of metabolic control and allows reducing the daily insulin requirement. Yet, no conclusions have been made so far whether this effect holds in later years. These results should be approached with caution because of the methodological limitations of the analyzed studies.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Child
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 1 / psychology
  • Glycated Hemoglobin / metabolism
  • Humans
  • Injections, Subcutaneous
  • Insulin / administration & dosage
  • Insulin / therapeutic use*
  • Insulin Infusion Systems
  • Patient Satisfaction
  • Patient Selection
  • Quality of Life
  • Randomized Controlled Trials as Topic


  • Glycated Hemoglobin A
  • Insulin