CADTH RAPID RESPONSE REPORT: SUMMARY OF … Insulin Pumps Final.pdf · insulin pumps for pediatric and adult patients with either Type I or II Diabetes Mellitus. Methods A limited

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

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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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 (


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


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


Author

(Year)

Diabetes Type

Patient

Population


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


Author

(Year)

Diabetes Type

Patient

Population


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


Author

(Year)

Diabetes Type

Patient

Population


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


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


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



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


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.


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


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


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


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


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


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

Documents

CADTH RAPID RESPONSE REPORT: SUMMARY OF … Insulin Pumps Final.pdf · insulin pumps for pediatric and adult patients with either Type I or II Diabetes Mellitus. Methods A limited