Date of Award

2021

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “In patients with type 1 diabetes mellitus, does insulin pump therapy provide greater patient satisfaction than use of multiple daily injections?”

STUDY DESIGN: Review of two randomized controlled trials (RCT’s) and one cross-sectional study. All studies were published in English.

DATA SOURCES: The two randomized controlled trials and one cross-sectional study were found via Cochrane Collaboration and PubMed. All sources were published in peer-reviewed journals and were chosen based on their relevance to the clinical question.

OUTCOMES MEASURED: The primary outcome measured in the selective EBM review was treatment satisfaction. Treatment satisfaction was measured using an Insulin Treatment Satisfaction Questionnaire (ITSQ)- based on six items of insulin device delivery satisfaction, an eight-item treatment satisfaction questionnaire (scored on a 1-5 scale), and a treatment satisfaction questionnaire (scored on a 7-point Likert scale).

RESULTS: In a cross-sectional study conducted by Hussain et al., insulin pump users showed a statistically significant increase in treatment satisfaction than those on multiple daily injections. Overall mean of scale for treatment satisfaction questions was 25.3 and 29.7 for the MDI and pump treatment groups, respectively. In an RCT by Speight et al., ITSQ scores were analyzed at the 6-month RCT interval, in which insulin pump participants reported a statistically significant increase in satisfaction with their insulin “device delivery” than those allocated to MDI (94.4 and 75.0), respectively. Lastly, in an RCT by Thrailkill et al., patients using insulin pump therapy reported a statistically significant increase in satisfaction with form of treatment compared to those allocated to MDI. At 12 months, 2.7 times the odds were reported in favor of the insulin pump treatment group (OR = 2.74, 95% confidence interval 1.41, 5.29, P = 0.001).

CONCLUSIONS: All three studies in this evidence-based review confirmed that in patients with type 1 diabetes, insulin pump therapy provides greater treatment satisfaction that use of multiple daily injections. Future trials emphasizing increased sampling sizes and expanded follow-up intervals may be found beneficial in supporting this data.

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