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This report is from AHRQ's series on Future Research Needs Projects.
Our recent systematic review examined specific questions about the comparative effectiveness of insulin delivery and glucose monitoring methods. The review found that intensive insulin therapy delivered either by continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) is equally effective in lowering glycated hemoglobin (HbA1c) levels in adolescents and adults with type 1 diabetes. Intensive insulin therapy delivered by both methods resulted in similar rates of severe hypoglycemia for adolescents and adults with type 1 diabetes. The review also found evidence that real-time continuous glucose monitoring (rt-CGM) is superior to self-monitoring of blood glucose (SMBG) in lowering HbA1c, without altering the risk balance of severe hypoglycemia, particularly among those who are compliant with wearing the monitoring device. Even though CSII and MDI without rt-CGM have similar effects on HbA1c, the addition of rt-CGM to CSII is superior to MDI/SMBG in lowering HbA1c. Thus, the addition of this monitoring method to SMBG and intensive insulin therapy can assist in achieving glycemic targets in individuals with type 1 diabetes. However, the review also identified several important gaps in the evidence. The objective of this report is to prioritize the needs for research addressing those gaps in the existing literature on management of insulin-requiring diabetes by engaging expert stakeholders using a modified Delphi method.