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Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus

Type 1 diabetes results from a defect in insulin secretion, leading to elevated levels of plasma sugar or glucose and disturbances in carbohydrate, fat and protein metabolism. Complications may effect the eyes, kidneys, nerves and the cardiovascular system. Type 1 diabetes may occur at any age and it is one of the most common chronic diseases of childhood and adolescence. Type 1 diabetes impacts heavily on the lifestyle of the individual as well as their families. Since there is no cure or prevention for type 1 diabetes, life‐long insulin replacement and monitoring of blood glucose levels are required. It is vital that effective insulin therapy regimes are available for optimal management and to minimise blood glucose fluctuation (known as too low or too high blood sugar levels ‐ hypoglycaemia or hyperglycaemia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes

Diabetes is a condition in which glucose (sugar) in the blood is too high because the body does not respond to insulin or not enough insulin is made. Insulin is a hormone made by the pancreas, which allows glucose to enter the cells where it is used as fuel by the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus

Simple application of a single daily insulin injection in addition to oral hypoglycaemic agents may facilitate the initiation of insulin therapy in type 2 diabetes mellitus.This review examined 20 trials including 1,811 participants which compared insulin monotherapy with insulin in combination with oral hypoglycaemic agents (OHA) in insulin‐requiring patients with type 2 diabetes. The results suggest that a bedtime NPH insulin‐oral hypoglycaemic agent combination therapy regimen provides comparable glycaemic control to insulin monotherapy. Due to lack of studies it remains unclear whether insulin‐OHA combination regimens with metformin alone are superior to those with metformin plus a sulphonylurea. In most cases no significant differences in hypoglycaemic events were observed between insulin mono‐ and OHA combination therapy. No study assessed diabetes‐related morbidity or mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus

Short acting insulin analogues (Lispro, Aspart, Glulisine) act more quickly than regular human insulin. It can be injected immediately before meals and leads to lower blood sugar levels after food intake. Our analysis showed that short acting insulin analogues were almost identically effective to regular human insulin in long term glycaemic control and were associated with similar episodes of low blood sugar (hypoglycaemia). No information on late complications such as problems with the eyes, kidneys or feet are existing. Until long term safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Insulin detemir versus insulin glargine for type 2 diabetes mellitus

The two long‐acting insulin analogues (artificial insulins), insulin detemir or insulin glargine differ in their mechanism of attaining protracted action, leading to possible differences in glycaemic control and safety outcomes. Several studies have compared either insulin detemir or insulin glargine to NPH (Neutral Protamin Hagedorn) insulin. Research directly comparing both long‐acting insulin analogues is limited.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Type 1 diabetes: Types of insulin

Insulin therapy is essential for everyone who has type 1 diabetes and some people who have type 2 diabetes. Various types of insulin are available. They differ in terms of how quickly and how long they are effective, as well as in their chemical structure.Some types of insulin work quickly (short-acting insulin or rapid-acting insulin), while others only start to work after a certain amount of time, and then work over a longer time period (long-acting or basal insulin).Insulin can be extracted from the pancreas cells of pigs (porcine insulin) or cattle (bovine insulin) and prepared for use in humans. But nowadays most people use genetically engineered insulin for the treatment of diabetes. There are two types of genetically engineered insulin, known as human insulin and insulin analogues. Human insulin is similar to the insulin made in the human body. Insulin analogues have a different chemical structure, but they have a similar effect.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 29, 2017

Treatment with the growth factor, recombinant human insulin‐like growth factor I, for amyotrophic lateral sclerosis (motor neuron disease)

Recombinant human insulin‐like growth factor (rhIGF‐I) is a genetically engineered human protein. Theoretically, it is expected to enhance the survival of motor neurons which degenerate in amyotrophic lateral sclerosis (ALS, also known as motor neuron disease (MND)). It is given by daily subcutaneous injection (injection under the skin). Three randomised controlled trials (RCTs) involving 779 participants measured disease progression on special clinical rating scales of disease severity in ALS. The review authors collected data about adverse events from the included trials. The combined results from the two included studies that used the rating scale (AALSRS) showed a small significant benefit in favour of rhIGF‐I. Significant flaws in the trial designs make the statistically significant benefits in some outcomes of questionable relevance. There was an increased risk of injection site reactions with rhIGF‐I. A third study using a different outcome measure showed no difference between treatment and placebo. Taken together, the available RCTs do not provide information supporting the hypothesis that rhIGF‐I is an effective disease modifying treatment for ALS. All three included studies showed a high risk of bias. These issues very seriously detracted from the ability of this review to fulfil its objectives.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Insulin degludec (Tresiba) for diabetes in teenagers and children: Overview

In 2015 insulin degludec (trade name: Tresiba) was approved in Germany for the treatment of type 1 and type 2 diabetes in teenagers and children over the age of one. This drug is a long-acting insulin analogue. It is used to regulate blood sugar levels for up to 24 hours.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 1, 2015

Type 1 diabetes: Can continuous glucose monitoring improve insulin therapy?

Monitoring the levels of sugar in body tissue (continuous glucose monitoring, CGM) in addition to measuring blood sugar levels can improve therapy outcomes in people with insulin-dependent diabetes: CGM helps to reliably lower blood sugar without leading to more episodes of severe hypoglycemia (low blood sugar).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 29, 2017

Combinations of insulin and oral glucose‐lowering drugs for people with type 2 diabetes on insulin treatment

Many guidelines on type 2 diabetes recommend a glycosylated haemoglobin A1c (HbA1c) level below 7%. HbA1c levels in the blood express glucose or glycaemic control over a longer time period (two to three months). During the course of type 2 diabetes it will get more difficult to reach these levels with 'lifestyle' modification (diet, exercise or both) and oral glucose‐lowering agents alone. Finally, a substantial number of people will need insulin therapy for better glycaemic control. Insulin therapy can be initiated as insulin alone, called monotherapy (which means that oral glucose‐lowering medication will be stopped) or in combination with oral glucose‐lowering agents. In the former case, oral blood glucose‐lowering agents can be added at a later stage, if insulin monotherapy fails to achieve a good HbA1c level. Hypoglycaemia and weight gain are the most common and well known side effects of insulin therapy. Adding oral agents to insulin could reduce the required insulin dose and thus decrease these insulin‐related side effects. However, there could be other side effects specific to the various oral blood glucose‐lowering drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Using medication: Injections, suppositories and other dosage forms

For medications to reach the right place inside the body, a suitable dosage form is selected when they are produced. Tablets and ointments are just two of the many different possible dosage forms.The dosage form depends on various things, including what physical and chemical properties the drug has and where it should take effect. For example, medicine that should have an effect on the lungs can be breathed in. Drugs for treating a vaginal infection can be inserted using a vaginal suppository. Drugs that are absorbed into the body through the mucous membranes lining the mouth can also be taken in the form of chewing gum. One well-known example is nicotine gum for helping to quit smoking.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 31, 2012

Enhanced glucose control for preventing and treating diabetic neuropathy

Diabetes is defined as high sugar levels in the blood. There are two forms of the disease. In type 1 diabetes, the body does not produce enough insulin. In type 2 diabetes, the body becomes less responsive to insulin. Regardless of the type of diabetes, many people develop a disabling neuropathy. Neuropathy is a condition that results in numbness, tingling, pain, or weakness that typically starts in the feet and progresses up the legs. The distribution is often described as a stocking glove pattern since the feet are affected first followed by the legs and fingers. The most common treatment for diabetes is control of blood sugar levels in an attempt to prevent the many complications, including neuropathy. This review identified 17 randomized studies that addressed whether more aggressive attempts to lower blood glucose levels prevent people from developing neuropathy. Seven of these studies were conducted in people with type 1 diabetes, eight in type 2 diabetes, and two in both types. However, only two studies in type 1 diabetes including 1228 participants and four studies in type 2 diabetes including 6669 participants investigated our primary outcome. In type 1 diabetes, there was a significant effect of more aggressive therapies in preventing neuropathy compared with standard treatment. In type 2 diabetes, more aggressive therapy was also beneficial in preventing symptoms and signs of clinical neuropathy, but the result was not statistically significant as measured by the primary method selected for this review. However, there was a significant positive effect on the amount of nerve damage measured with electrical nerve conduction tests and a special machine to measure the threshold of detection of vibration in both types of diabetes. Overall, the evidence indicates that more aggressive treatments of sugar levels delay the onset of neuropathy in both types of diabetes. No other treatments have proven effective to date. However, the beneficial effect has to be balanced against the significantly increased risk of dangerously low blood sugar levels that can occur in both types of diabetes and which can lead to brain injury amongst other issues.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Hormone contraceptives and how the body uses carbohydrates in women without diabetes

Hormone contraceptives may change how the body handles carbohydrates (starches and sugars). Changes may include lower ability to use sugar from food and more problems with the body's insulin. Insulin is a hormone that helps the body use sugar. Problems with blood sugar can increase risk for diabetes and heart disease. These issues have been raised mainly with birth control methods that contain the hormone estrogen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Type 2 diabetes: Overview

Being diagnosed with type 2 diabetes can come as a real surprise. High blood sugar levels are often first detected during a routine examination. Some people just have to make a few changes in their routines after being diagnosed, while others need permanent medication.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 4, 2014

Albiglutide (Eperzan) for type 2 diabetes: Overview

Albiglutide (trade name: Eperzan) has been approved in Germany since March 2014 for the treatment of type 2 diabetes in adults who cannot lower high blood sugar levels enough through exercise and diet alone.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 2, 2015

Comparing newer drugs for diabetes, including combination drugs

How do newer drugs for diabetes compare in lowering blood sugar levels?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: May 16, 2011

How is gestational diabetes treated?

Elevated blood sugar levels can usually be lowered enough by changing your diet. Special dietary counseling can help. Some women with gestational diabetes have to inject insulin because they have high blood sugar for a long period of time.In gestational diabetes (diabetes in pregnancy), women's blood sugar levels are temporarily higher than usual. This is usually not a reason for concern. But gestational diabetes can increase the risk of rare complications in pregnancy and during childbirth. It is diagnosed using a test known as the glucose tolerance test.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 29, 2017

Medicines for Type 2 Diabetes: A Review of the Research for Adults

This summary covers the research on the benefits and possible side effects of medicines to lower or control your blood sugar. It will help you talk with your doctor or other health care professional to decide which medicines are best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 30, 2011

Oral anti‐diabetic agents for women with pre‐existing diabetes mellitus, impaired glucose tolerance or previous gestational diabetes mellitus

Pregnant women with type 1 or type 2 diabetes are at a greater risk of adverse outcomes in pregnancy, such as miscarriage or large babies and preterm birth. Being pregnant can trigger diabetes in women with impaired glucose tolerance or can accelerate the development of diabetic complications in women who are already diabetic. Women who have gestational diabetes are at risk of developing diabetes later in life. This means that management is important for women with diabetes and also for women with impaired glucose tolerance or previously diagnosed gestational diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Oral steroids, splinting, ultrasound, yoga and wrist mobilisation provide short‐term relief from carpal tunnel syndrome, but other non‐surgical methods have not been shown to help.

Carpal tunnel syndrome is caused by compression of the median nerve at the wrist, leading to mild to severe pain and pins and needles in the hand. Other Cochrane reviews show benefit from nerve decompression surgery and steroids. This review of other non‐surgical treatments found some evidence of short‐term benefit from oral steroids, splinting/hand braces, ultrasound, yoga and carpal bone mobilisation (movement of the bones and tissues in the wrist), and insulin and steroid injections for people who also had diabetes. Evidence on ergonomic keyboards and vitamin B6 is unclear, while trials so far have not shown benefit from diuretics, non‐steroidal anti‐inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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