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Service Line: Rapid Response Service
Version: 1.0
Publication Date: December 13, 2018
Report Length: 13 Pages
CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS
Insulin Pumps for Patients with Any Diabetes Type: Clinical Effectiveness and Guidelines
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 2
Authors: Camille Dulong, Monika Mierzwinski-Urban
Cite As: Insulin Pumps for Patients with Any Diabetes Type: Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2018 December. (CADTH rapid response
report: summary of abstracts).
Acknowledgments:
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Funding: CADTH receives funding from Canadas federal, provincial, and territorial governments, with the exception of Quebec.
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 3
Research Questions
1. What is the clinical effectiveness of insulin pumps for patients with any type of diabetes?
2. What are the evidence-based guidelines associated with use of insulin pumps for
patients with any type of diabetes?
Key Findings
Six systematic reviews with meta-analyses, eight randomized controlled trials, and one
evidence-based guideline were identified regarding the clinical effectiveness and safety of
insulin pumps for pediatric and adult patients with either Type I or II Diabetes Mellitus.
Methods
A limited literature search was conducted on key resources including PubMed, the
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases, Canadian and major international health technology agencies, as well as a
focused Internet search. Methodological filters were applied to limit retrieval to health
technology assessments, systematic reviews, meta-analyses, and guidelines. A focused
search for randomized controlled trials was also conducted. For this search, the main
concepts appeared in the title or as a major subject heading and filters were applied to limit
retrieval to randomized controlled trials. Both searches were limited to English language
documents published between January 1, 2013 and November 29, 2018. Internet links
were provided, where available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria
presented in Table 1.
Table 1: Selection Criteria
Population Patients with Type I or gestational Diabetes Mellitus Pediatric population (
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 4
Results
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta-analyses
are presented first. These are followed by randomized controlled trials and evidence-based
guidelines.
Six systematic reviews and meta-analyses, eight randomized controlled trials and one
evidence-based guideline was identified regarding insulin pumps for pediatric and adult
patients with either Type I or II Diabetes Mellitus. No relevant health technology
assessments were identified.
Additional references of potential interest are provided in the appendix.
Overall Summary of Findings
Two systematic reviews (SR) with meta-analyses (MA),1,2 were identified for pediatric
patients with Type I Diabetes Mellitus (TIDM). Both studies compared continuous
subcutaneous insulin infusion (CSII) to multiple daily injections (MDI) in patients. Overall,
both studies concluded that glycosylated hemoglobin levels were significantly reduced in
the CSII group compared to the MDI group.1,2
The third SR included a MA3 for Type II Diabetes Mellitus (TIIDM) comparing CSII to MDI,
although the patient population was not specified. Similar to the previously identified SRs,1,2
the CSII group achieved a greater reduction in glycosylated hemoglobin levels as well as a
reduction in insulin uptake.3
The fourth SR with MA examined gestational diabetes patients, again comparing CSII to
MDI.4 Generally, CSII improved glycemic control in the first trimester compared to MDI but
the improvements did not last up until the last trimester.4
The fifth SR with MA5 assessed patients with gestational diabetes while comparing CSII to
MDI. Overall, no key differences were identified between groups although the CSII group
had higher birth weights compared to the MDI group.5
The authors of the last identified SR6 assessed patients with gestational diabetes. No
significant differences among groups regarding glycosylated hemoglobin levels and
maternal or fetal outcomes were reported.6
Three randomized controlled trials (RCTs)7-9 were assessed for adult patients with TIIDM.
One trial7 compared two different infusion sets to one another while another trial8 compared
insulin pumps (the type not specified) to MDI. The last trial9 compared CSII with real time-
glucose monitoring (RT) to MDI with self-monitoring blood glucose (SMBG). All three
studies reported that glycemic control levels were similar among comparative groups.7-9
Another RCT10 was identified and included pediatric and adult patients with TIDM. The trial
compared sensor-augmented pumps (SAP) with low glucose suspension to standard insulin
pumps. SAP therapy with low glucose suspension reduced the combined rate of severe and
moderate hypoglycemia in patients compared to standard insulin pump therapy.10
An RCT11 was identified that included pediatric patients with TIDM, comparing CSII to MDI.
Overall, the researchers concluded there was no clinical benefit associated with one type of
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 5
therapy over another as glycosylated hemoglobin concentration was comparable among
groups.11
Three RCTs12-14 were identified that included unspecified patient populations with TIDM.
The first trial12 compared CSII to MDI with glargine therapy in unselected patients with TIDM
using continuous glucose monitoring (CGM). Researchers observed that glycosylated
hemoglobin levels significantly improved in the CSII group compared to the MDI with
glargine group.12 The second trial13 compared SAP to MDI and the effects these therapies
had on albuminuria among selected patients. The researchers concluded that the SAP
group had lower glucose variability and glycosylated hemoglobin levels compared to the
MDI group as well as decreasing the urine albumin creatine ratio among SAP patients.13
The third trial14 compared SAP therapy with or without the threshold-glucose suspend
among selected patients. Researchers concluded that the SAP threshold-suspend group
had a reduction nocturnal hypoglycemia, without increasing glycated hemoglobin values
compared to the standard SAP therapy.14
The guideline by the National Institute for Health and Care Excellence (NICE) outlines
specific outcomes that are necessary for optimal control of diabetes along with potential
therapies that may be most suitable for both types of diabetes in pediatric patients.15
Table 2: Included Studies
Author
(Year)
Diabetes Type
Patient
Population
Intervention Comparator Outcomes Results
Systematic Reviews and Meta-analyses
Benkhadra (2017)1
TIDM Pediatric (< 18
years) and adult
( 18 years)
patients
CSII MDI HbA1c levels
Hypoglycemic events
Time spent in hypoglycemia
MA showed significant reduction in HbA1c levels in t CSII group for both adults and children
No different in hypoglycemic events and time spent in hypoglycemia between groups
Qin (2017)2 TIDM Pediatric (< 18
years) patients
CSII MDI HbA1c (%) change
Total daily insulin injections
Incidence of DKA
Incidence of severe hypoglycemia
8 studies included
HbA1c lower in children treated with CSII compared to MDI
No differences in incidence of DKA or severe hypoglycemia
Pickup (2017)3
TDIIM Not specified CSII MDI HbA1c levels
Insulin dosing
5 trials identified
CSII achieved greater reduction in HbA1c levels than MDI
26% reduction in insulin
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 6
Author
(Year)
Diabetes Type
Patient
Population
Intervention Comparator Outcomes Results
Rys (2018)4 Gestational diabetes
Pregnant patients
CSII MDI GWG
Insulin dosing
HbA1c levels
47 studies identified
CSII resulted in GWG and lower daily insulin dosing
CSII resulted in improved glycemic control in first trimester and lower insulin requirements
Farrar (2016)5
Pre-existing and gestational diabetes
Pregnant patients
CSII MDI C-section
Large for gestational age
Perinatal mortality
Birthweight
Development of TIIDM
Maternal weight gain
Mean blood glucose levels pre trimester
Hyperglycemia
Hypoglycemia
5 studies included
No key differences in primary outcomes between trials
Increased birth weight with CSII compared to MDI
Ranasinghe (2015)6
Gestational diabetes
Pregnant patients
CSII MDI HbA1c levels
Maternal and fetal outcomes
7 studies included
MA showed no difference in maternal or fetal outcomes
Similar improvements in HbA1c levels in both groups
Randomized Controlled Trials
Freckman (2017)7
TIDM Adults ( 18 years) patients N=80
IIS: Accu-Chek FlexLink Plus (FL plus)
IIS: Accu-Chek FlexLink infusion set (FL)
VAS (pain outcomes)
AEs
Similar pain outcomes reported in both groups
13 patients experienced AEs
2 patients experienced SAEs
RESPONSE Study Group (2017)8
TIDM Adults ( 18 years) patients N=317
Insulin pump MDI Change in HbA1c levels at 2 years
Proportion of patients achieving HbA1c 7.5%
HbA1c levels, severe hypoglycemia improved in both groups
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 7
Author
(Year)
Diabetes Type
Patient
Population
Intervention Comparator Outcomes Results
Little (2014)9 TIDM Adults ( 18 years) patients N=96
CSII
RT-CGM
MDI
SMBG
Hypoglycemia awareness
Severe hypoglycemia
Biochemical hypoglycemia
At 24 weeks, there was no significant difference in awareness comparing CSII with MDI and RT-CGM with SMBG
Treatment satisfaction higher in CSII group than MDI group
Similar biomedical outcomes attained with MDI and SMBG regimens compared with CSII/RT-CGM
Ly (2013)10 TIDM Pediatric (< 18 years) and adult ( 18 years) patients N=95
Sensor-augmented pump with low-glucose suspension pump (n= 49)
Standard insulin pump therapy (n=46)
Incidence of severe or moderate hypoglycemia
DKA
Event rates of severe and moderate hypoglycemia decreased in both groups
There was no change in glycated hemoglobin in either group
Blair (2018)11 TIDM Pediatric (< 18 years) patients N=293
CSII MDI Change in HbA1c levels
HbA1c concentrations of < 48 mmol/mol
Severe hypoglycemia
DKA
Treatment-related AE
Bodyweight
Insulin requirement
QoL
HbA1c concentrations at 12 months were comparable
Severe hyperglycemia and DKA was low in both groups
Insulin use and AEs were higher in the CSII groups compared to MDI group
Ruiz-de-Adana (2016)12
TIDM Not specified N=45
CSII (using CGM)
MDI with glargine (using CGM)
HbA1c levels
QoL
Hypoglycemia rate
DKA
Significant improvements in HbA1c levels for CSII group
Rosenlund (2015)13
TIDM Not specified N=55
SAP (n= 26) MDI (n= 29) UACR
HbA1c levels
Glucose variability
GFR
UACR was reduced significantly in SAP group compared to MDI
HbA1c levels and glucose variability also decreased more in SAP compared to MDI
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 8
Author
(Year)
Diabetes Type
Patient
Population
Intervention Comparator Outcomes Results
Bergenstal (2013)14
TIDM Unspecified N=247
Threshold-suspend SAP (n=121)
Standard SAP (n=126)
Nocturnal hypoglycemic events
HbA1c levels
HbA1c values were similar between groups
Nocturnal hypoglycemic events were lower in threshold-suspend SAP group compared to standard SAP group
AE = adverse event; CSII = continuous subcutaneous insulin infusion; DKA = diabetic ketoacidosis; FL = FlexLink; GCR = glomerular filtration rate; GWG = gestational
weight gain; HbA1c = hemoglobin A1C; IIS = insulin infusion sets; MA = meta-analysis; MDI multiple daily injections; QoL = quality of life; RT-CGM = real-time
continuous glucose monitoring; SAE = serious adverse event; SAP = sensor-augmented insulin pump; SMBG = self-monitoring of blood glucose; TIDM = Type I Diabetes
Mellitus; TIIDM Type II Diabetes Mellitus; UACR = urine albumin creatinine ratio; VAS = visual analog scale.
References Summarized
Health Technology Assessments
No literature identified.
Systematic Reviews and Meta-analyses
Type I Diabetes
Mixed Population - Pediatric and Adult Populations Included
1. Benkhadra K, Alahdab F, Tamhane SU, McCoy RG, Prokop LJ, Murad MH. Continuous
subcutaneous insulin infusion versus multiple daily injections in individuals with type 1
diabetes: a systematic review and meta-analysis. Endocrine. 2017 Jan;55(1):77-84.
PubMed: PM27477293
Pediatric Population
2. Qin Y, Yang LH, Huang XL, Chen XH, Yao H. Efficacy and safety of continuous
subcutaneous insulin infusion vs. multiple daily injections on type 1 diabetes children
aged
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SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 9
Gestational Diabetes
4. Rys PM, Ludwig-Slomczynska AH, Cyganek K, Malecki MT. Continuous subcutaneous
insulin infusion vs multiple daily injections in pregnant women with type 1 diabetes
mellitus: a systematic review and meta-analysis of randomised controlled trials and
observational studies. Eur J Endocrinol. 2018 May;178(5):545-563.
PubMed: PM29545258
5. Farrar D, Tuffnell DJ, West J, West HM. Continuous subcutaneous insulin infusion
versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane
Database Syst Rev. 2016 Jun 7(6):Cd005542.
PubMed: PM27272351
6. Ranasinghe PD, Maruthur NM, Nicholson WK, et al. Comparative effectiveness of
continuous subcutaneous insulin infusion using insulin analogs and multiple daily
injections in pregnant women with diabetes mellitus: a systematic review and meta-
analysis. J Womens Health (Larchmt). 2015 Mar;24(3):237-249.
PubMed: PM25713996
Randomized Controlled Trials
Type I Diabetes
Adult Population
7. Freckmann G, Arndt S, Fiesselmann A, et al. Randomized cross-over study comparing
two infusion sets for CSII in daily life. J Diabetes Sci Technol. 2017 Mar;11(2):253-259.
PubMed: PM27605591
8. RESPONSE Study Group. Relative effectiveness of insulin pump treatment over
multiple daily injections and structured education during flexible intensive insulin
treatment for type 1 diabetes: cluster randomised trial (REPOSE). BMJ. 2017 Mar
30;356:j1285.
PubMed: PM28360027
9. Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia awareness in
long-standing type 1 diabetes: a multicenter 2 x 2 factorial randomized controlled trial
comparing insulin pump with multiple daily injections and continuous with conventional
glucose self-monitoring (HypoCOMPaSS). Diabetes Care. 2014 Aug;37(8):2114-2122.
PubMed: PM24854041
Mixed Population - Adult and Pediatric Population
10. Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW. Effect of sensor-
augmented insulin pump therapy and automated insulin suspension vs standard insulin
pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical
trial. JAMA. 2013 Sep 25;310(12):1240-1247.
PubMed: PM24065010
http://www.ncbi.nlm.nih.gov/pubmed/29545258http://www.ncbi.nlm.nih.gov/pubmed/27272351http://www.ncbi.nlm.nih.gov/pubmed/25713996http://www.ncbi.nlm.nih.gov/pubmed/27605591http://www.ncbi.nlm.nih.gov/pubmed/28360027http://www.ncbi.nlm.nih.gov/pubmed/24854041http://www.ncbi.nlm.nih.gov/pubmed/24065010 -
SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 10
Pediatric Population
11. Blair J, McKay A, Ridyard C, et al. Continuous subcutaneous insulin infusion versus multiple daily injections in children and young people at diagnosis of type 1 diabetes: the SCIPI RCT. Health Technol Assess. 2018 Aug;22(42):1-112.
PubMed: PM30109847
Unspecified Ages of Population
12. Ruiz-de-Adana MS, Dominguez-Lopez ME, Gonzalez-Molero I, et al. Comparison
between a multiple daily insulin injection regimen (basal once-daily glargine plus
mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous
glucose monitoring in metabolically optimized type 1 diabetes patients: a randomized
open-labelled parallel study. Med Clin (Barc). 2016 Mar 18;146(6):239-246.
PubMed: PM26656958
13. Rosenlund S, Hansen TW, Rossing P, Andersen S. Effect of sensor-augmented pump
treatment versus multiple daily injections on albuminuria: a 1-year randomized study. J
Clin Endocrinol Metab. 2015 Nov;100(11):4181-4188.
PubMed: PM26390102
14. Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption
for reduction of hypoglycemia. N Engl J Med. 2013 Jul 18;369(3):224-232.
PubMed: PM23789889
Guidelines and Recommendations
Mixed Population
Different Diabetes Types
15. National Collaborating Centre for Women's and Children's Health (UK). Diabetes (type 1
and type 2) in children and young people: diagnosis and management. London (GB):
National Institute for Health and Care Excellence; 2015.
PubMed: PM26334077
http://www.ncbi.nlm.nih.gov/pubmed/30109847http://www.ncbi.nlm.nih.gov/pubmed/26656958http://www.ncbi.nlm.nih.gov/pubmed/26390102http://www.ncbi.nlm.nih.gov/pubmed/23789889http://www.ncbi.nlm.nih.gov/pubmed/26334077 -
SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 11
Appendix Further Information
Previous CADTH Reports
16. Continuous subcutaneous insulin infusion for type 1 diabetes: clinical effectiveness,
cost-effectiveness, and guidelines. (CADTH Rapid response report: reference list).
Ottawa (ON): CADTH; 2015:
https://www.cadth.ca/sites/default/files/pdf/htis/apr-
2015/RA0750%20Insulin%20Pumps%20for%20Type%201%20Diabetes%20Final.pdf.
Accessed 2018 Dec 13.
17. Insulin pumps for adults with type 1 diabetes: a review of clinical effectiveness, cost-
effectiveness and guidelines. (CADTH Rapid response report: summary with critical
appraisal). Ottawa (ON): CADTH; 2015:
https://www.cadth.ca/sites/default/files/pdf/htis/dec-
2015/RC0731_Insulin%20pumps_Final.pdf. Accessed 2018 Dec 13.
Health Technology Assessments Summary Provided Yet Methods
Unspecified
Mixed Population Adult and Pediatric Population
18. Summary and overall assessment (knowledge base insulin pump and CGM). Stockholm
(SE): Swedish Dental and Pharmaceutical Benefits Agency; 2014.
https://www.tlv.se/download/18.1d85645215ec7de2846d07e8/1510316395084/summer
y_knowledge_base_insulin_pump_cgm.pdf. Accessed 2018 Dec 13.
Randomized Controlled Trials
Alternative Outcome
Type I Diabetes
Adult Population
19. Pfutzner A, Sachsenheimer D, Grenningloh M, et al. Using insulin infusion sets in CSII
for longer than the recommended usage time leads to a high risk for adverse events:
results from a prospective randomized crossover study. J Diabetes Sci Technol. 2015
Sep 3;9(6):1292-1298.
PubMed: PM26341262
Pediatric Population
Alternative Comparator 20. Forlenza GP, Raghinaru D, Cameron F, et al. Predictive hyperglycemia and
hypoglycemia minimization: in-home double-blind randomized controlled evaluation in
children and young adolescents. Pediatr Diabetes. 2018 May;19(3):420-428.
PubMed: PM29159870
https://www.cadth.ca/sites/default/files/pdf/htis/apr-2015/RA0750%20Insulin%20Pumps%20for%20Type%201%20Diabetes%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/apr-2015/RA0750%20Insulin%20Pumps%20for%20Type%201%20Diabetes%20Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/dec-2015/RC0731_Insulin%20pumps_Final.pdfhttps://www.cadth.ca/sites/default/files/pdf/htis/dec-2015/RC0731_Insulin%20pumps_Final.pdfhttps://www.tlv.se/download/18.1d85645215ec7de2846d07e8/1510316395084/summery_knowledge_base_insulin_pump_cgm.pdfhttps://www.tlv.se/download/18.1d85645215ec7de2846d07e8/1510316395084/summery_knowledge_base_insulin_pump_cgm.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/26341262http://www.ncbi.nlm.nih.gov/pubmed/29159870 -
SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 12
Non-Randomized Studies
Type I Diabetes
Adult Population
21. Meade LT, Tart RC, Nuzum D. Clinical experience with U-500 regular insulin by multiple
daily injections and continuous subcutaneous insulin infusion. Diabetes Technol Ther.
2017 Apr;19(4):220-225.
PubMed: PM28249123
No Comparator
Pediatric Population
22. Brancato D, Fleres M, Aiello V, et al. The effectiveness and durability of an early insulin
pump therapy in children and adolescents with type 1 diabetes mellitus. Diabetes
Technol Ther. 2014 Nov;16(11):735-741.
PubMed: PM25162664.
Population Not Specified
23. Rosenlund S, Hansen TW, Andersen S, Rossing P. Effect of 4 years subcutaneous
insulin infusion treatment on albuminuria, kidney function and HbA1c compared with
multiple daily injections: a longitudinal follow-up study. Diabet Med. 2015
Nov;32(11):1445-1452.
PubMed: PM26331364
Pediatric Population and Real World Outcomes
24. Burckhardt MA, Smith GJ, Cooper MN, Jones TW, Davis EA. Real-world outcomes of
insulin pump compared to injection therapy in a population-based sample of children
with type 1 diabetes. Pediatr Diabetes. 2018 Dec;19(8):1459-1466.
PubMed: PM30129154
Clinical Practice Guidelines Unspecified Methodology
Type I Diabetes
Pediatric Population
25. Lawrence SE, Cummings EA, Pacaud D, Lynk A, Metzger DL. Managing type 1
diabetes in school: recommendations for policy and practice. Paediatr Child Health.
2015 Jan-Feb;20(1):35-44.
PubMed: PM25722642
26. Insulin pump therapy: management guideline. Glasgow: Greater Glasgow and Clyde
Children's Diabetes Service; 2014.
https://www.diabetes-
scotland.org/ggc/documents/pdf_files/2014030101%20Insulin%20Pump%20Therapy%2
0Guideline%20(Opt%20PDF).pdf. Accessed 2018 Dec 13.
http://www.ncbi.nlm.nih.gov/pubmed/28249123http://www.ncbi.nlm.nih.gov/pubmed/25162664http://www.ncbi.nlm.nih.gov/pubmed/26331364http://www.ncbi.nlm.nih.gov/pubmed/30129154http://www.ncbi.nlm.nih.gov/pubmed/25722642https://www.diabetes-scotland.org/ggc/documents/pdf_files/2014030101%20Insulin%20Pump%20Therapy%20Guideline%20(Opt%20PDF).pdfhttps://www.diabetes-scotland.org/ggc/documents/pdf_files/2014030101%20Insulin%20Pump%20Therapy%20Guideline%20(Opt%20PDF).pdfhttps://www.diabetes-scotland.org/ggc/documents/pdf_files/2014030101%20Insulin%20Pump%20Therapy%20Guideline%20(Opt%20PDF).pdf -
SUMMARY OF ABSTRACTS Insulin Pumps in Patients with Any Diabetes Type 13
Gestational Diabetes
27. Seshiah V, Banerjee S, Balaji V, Muruganathan A, Das AK. Consensus evidence-based
guidelines for management of gestational diabetes mellitus in India. J Assoc Physicians
India. 2014 Jul;62(7 Suppl):55-62.
PubMed: PM25668938.
Type I Diabetes
28. Best practice guide: continuous subcutaneous insulin infusion (CSII). A clinical guide for
adult diabetes services. Knowle (GB): Association of British Clinical Diabetologists;
2018. https://abcd.care/sites/abcd.care/files/BP_DTN_v13%20FINAL.pdf. Accessed
2018 Dec 13.
Mixed Population Type I and Gestational Diabetes
29. Guidelines for the safe management of insulin pump therapy in hospital. Edmonton
(AB): Alberta Health Services; 2017.
https://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-scn-don-guidelines-for-
safe-management-of-ipt-in-hospital.pdf. Accessed 2018 Dec 13.
Diabetes Type and Population Age Unspecified
30. Gangopadhyay KK, Bantwal G, Talwalkar PG, Muruganathan A, Das AK. Consensus
evidence-based guidelines for in-patient management of hyperglycaemia in non-critical
care setting as per Indian clinical practice. J Assoc Physicians India. 2014 Jul;62(7
Suppl):6-15.
PubMed: PM25668932
Diabetes Type Not Specified
31. Kesavadev J, Jain SM, Muruganathan A, Das AK. Consensus evidence-based
guidelines for use of insulin pump therapy in the management of diabetes as per Indian
clinical practice. J Assoc Physicians India. 2014 Jul;62(7 Suppl):34-41.
PubMed: PM25668935
http://www.ncbi.nlm.nih.gov/pubmed/25668938https://abcd.care/sites/abcd.care/files/BP_DTN_v13%20FINAL.pdfhttps://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-scn-don-guidelines-for-safe-management-of-ipt-in-hospital.pdfhttps://extranet.ahsnet.ca/teams/policydocuments/1/clp-ahs-scn-don-guidelines-for-safe-management-of-ipt-in-hospital.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/25668932http://www.ncbi.nlm.nih.gov/pubmed/25668935