Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Stephanie A. Fisher; Jingtong Huang; Ashley Y. DuBord; Nicole Y. Xu; Molly Beestrum; Charlotte Niznik; Andrea M. Yeung; Kevin T. Nguyen; David C. Klonoff; Lynn M. Yee

doi:10.1177/19322968231186626

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Stephanie A. Fisher^*, Jingtong Huang, Ashley Y. DuBord, Nicole Y. Xu, Molly Beestrum, Charlotte Niznik, Andrea M. Yeung, Kevin T. Nguyen, David C. Klonoff, Lynn M. Yee

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. Methods: A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. Results: Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. Conclusions: Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.

Original language	English (US)
Pages (from-to)	1337-1363
Number of pages	27
Journal	Journal of Diabetes Science and Technology
Volume	17
Issue number	5
DOIs	https://doi.org/10.1177/19322968231186626
State	Published - Sep 2023

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: SAF, CN, MB, LMY have no funding sources relevant to this article to disclose. JH, AYD, NYX, AMY, KTN, DCK have received funding from Diabetes Technology Society. This work was presented as a poster at the Society of Maternal Fetal Medicine 43rd Annual Pregnancy Meeting, February 6 to 11, 2023; San Francisco, CA. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: SAF, CN, MB, LMY have no funding sources relevant to this article to disclose. JH, AYD, NYX, AMY, KTN, DCK have received funding from Diabetes Technology Society.

Keywords

continuous subcutaneous insulin infusion
insulin
maternal morbidity
multiple daily injections
neonatal morbidity
pregnancy

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Bioengineering
Biomedical Engineering

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/19322968231186626

Cite this

Fisher, S. A., Huang, J., DuBord, A. Y., Xu, N. Y., Beestrum, M., Niznik, C., Yeung, A. M., Nguyen, K. T., Klonoff, D. C., & Yee, L. M. (2023). Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. Journal of Diabetes Science and Technology, 17(5), 1337-1363. https://doi.org/10.1177/19322968231186626

@article{489fa279448a4c4d93471b811d192c95,

title = "Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis",

abstract = "Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. Methods: A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. Results: Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. Conclusions: Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.",

keywords = "continuous subcutaneous insulin infusion, insulin, maternal morbidity, multiple daily injections, neonatal morbidity, pregnancy",

author = "Fisher, {Stephanie A.} and Jingtong Huang and DuBord, {Ashley Y.} and Xu, {Nicole Y.} and Molly Beestrum and Charlotte Niznik and Yeung, {Andrea M.} and Nguyen, {Kevin T.} and Klonoff, {David C.} and Yee, {Lynn M.}",

note = "Publisher Copyright: {\textcopyright} 2023 Diabetes Technology Society.",

year = "2023",

month = sep,

doi = "10.1177/19322968231186626",

language = "English (US)",

volume = "17",

pages = "1337--1363",

journal = "Journal of Diabetes Science and Technology",

issn = "1932-2968",

publisher = "SAGE Publications Inc.",

number = "5",

}

Fisher, SA, Huang, J, DuBord, AY, Xu, NY, Beestrum, M, Niznik, C, Yeung, AM, Nguyen, KT, Klonoff, DC & Yee, LM 2023, 'Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis', Journal of Diabetes Science and Technology, vol. 17, no. 5, pp. 1337-1363. https://doi.org/10.1177/19322968231186626

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. / Fisher, Stephanie A.; Huang, Jingtong; DuBord, Ashley Y. et al.
In: Journal of Diabetes Science and Technology, Vol. 17, No. 5, 09.2023, p. 1337-1363.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy

T2 - A Systematic Review and Meta-Analysis

AU - Fisher, Stephanie A.

AU - Huang, Jingtong

AU - DuBord, Ashley Y.

AU - Xu, Nicole Y.

AU - Beestrum, Molly

AU - Niznik, Charlotte

AU - Yeung, Andrea M.

AU - Nguyen, Kevin T.

AU - Klonoff, David C.

AU - Yee, Lynn M.

PY - 2023/9

Y1 - 2023/9

N2 - Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. Methods: A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. Results: Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. Conclusions: Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.

AB - Background: The use of continuous subcutaneous insulin infusion (CSII) therapy in pregnancies affected by pregestational diabetes mellitus (DM) has generated mixed outcome data worthy of further investigation. This systematic review and meta-analysis aims to evaluate clinical outcomes associated with CSII versus multiple daily injections (MDIs) in pregnant persons with pregestational DM. Methods: A predefined, systematic, librarian-assisted search of MEDLINE (PubMed), Embase, Cochrane Library, Scopus, ClinicalTrials.gov, and World Health Organization International Clinical Trial Registry Platform (published from 2010 to 2022) yielded 3003 studies describing pregnancy outcomes associated with CSII and/or MDI for pregestational DM. The primary exposure was mode of insulin administration, with cesarean delivery and neonatal hypoglycemia as the primary maternal and neonatal outcomes, respectively. Secondary outcomes included hypertensive disorders of pregnancy, first and third-trimester glycemic control, large-for-gestational age (LGA) neonate, preterm birth, neonatal intensive care unit admission, need for respiratory support, hyperbilirubinemia, 5-minute Apgar <7, shoulder dystocia, and perinatal mortality. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random-effects models. Results: Among 39 eligible studies, 39% of the 5518 pregnancies included were exposed to CSII. Odds of cesarean delivery were higher with CSII (20 studies: 63% vs 56%, odds ratio [OR] 1.3 [95% confidence interval (CI) 1.2-1.5]), but we did not identify a difference in the odds of neonatal hypoglycemia (23 studies: 31% vs 34%, OR 1.1 [95% CI 0.9-1.5]). Among secondary outcomes, only the odds of LGA (20 studies: 47% vs 38%, OR 1.4 [95% CI 1.2-1.6]) were higher in individuals using CSII versus MDI. Conclusions: Use of CSII (vs MDI) for pregestational DM in pregnancy is associated with higher odds of cesarean delivery and delivery of an LGA neonate. Further evaluation of how CSII use may influence neonatal size and delivery route is warranted.

KW - continuous subcutaneous insulin infusion

KW - insulin

KW - maternal morbidity

KW - multiple daily injections

KW - neonatal morbidity

KW - pregnancy

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U2 - 10.1177/19322968231186626

DO - 10.1177/19322968231186626

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AN - SCOPUS:85166947392

SN - 1932-2968

VL - 17

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EP - 1363

JO - Journal of Diabetes Science and Technology

JF - Journal of Diabetes Science and Technology

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ER -

Continuous Subcutaneous Infusion Versus Multiple Daily Injections of Insulin for Pregestational Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

Abstract

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Keywords

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UN SDGs

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