Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.

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Abstract

To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes.

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Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.

Jaime Peters, Alex J Sutton, David Jones … (2007)

The trim and fill method allows estimation of an adjusted meta-analysis estimate in the presence of publication bias. To date, the performance of the trim and fill method has had little assessment. In this paper, we provide a more comprehensive examination of different versions of the trim and fill method in a number of simulated meta-analysis scenarios, comparing results with those from usual unadjusted meta-analysis models and two simple alternatives, namely use of the estimate from: (i) the largest; or (ii) the most precise study in the meta-analysis. Findings suggest a great deal of variability in the performance of the different approaches. When there is large between-study heterogeneity the trim and fill method can underestimate the true positive effect when there is no publication bias. However, when publication bias is present the trim and fill method can give estimates that are less biased than the usual meta-analysis models. Although results suggest that the use of the estimate from the largest or most precise study seems a reasonable approach in the presence of publication bias, when between-study heterogeneity exists our simulations show that these estimates are quite biased. We conclude that in the presence of publication bias use of the trim and fill method can help to reduce the bias in pooled estimates, even though the performance of this method is not ideal. However, because we do not know whether funnel plot asymmetry is truly caused by publication bias, and because there is great variability in the performance of different trim and fill estimators and models in various meta-analysis scenarios, we recommend use of the trim and fill method as a form of sensitivity analysis as intended by the authors of the method. Copyright 2007 John Wiley & Sons, Ltd.

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Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes.

Richard M. Bergenstal, William Tamborlane, Andrew Ahmann … (2010)

Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors. In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams. The primary end point was the change from the baseline glycated hemoglobin level. At 1 year, the baseline mean glycated hemoglobin level (8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group, as compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached the glycated hemoglobin target (<7%) was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group. In both adults and children with inadequately controlled type 1 diabetes, sensor-augmented pump therapy resulted in significant improvement in glycated hemoglobin levels, as compared with injection therapy. A significantly greater proportion of both adults and children in the pump-therapy group than in the injection-therapy group reached the target glycated hemoglobin level. (Funded by Medtronic and others; ClinicalTrials.gov number, NCT00417989.) 2010 Massachusetts Medical Society