OBJECTIVES: To evaluate the efficacy and safety of continuous subcutaneous insulin infusion (CSII) or insulin pump in the treatment in patients with type 1 diabetes, who failed to receive multiple doses of insulin (MDI).

METHODS: We performed a search for systematic reviews in the Cochrane Library, Medline, Lilacs and Centre for Reviews and Dissemination (CRD) databases, until January 2018. A manual search was also conducted on the internet and in the references of the studies found. The eligibility criteria used to select these studies include patients with type 1 diabetes who did not achieve glycemic control with MDI therapy and started using CSII. The quality of the selected studies was evaluated using AMSTAR tool. The outcomes considered were differences in glycosylated hemoglobin (HbA1c) and hypoglycemic events.

RESULTS: A total of 116 studies were identified and five were selected. The observed benefit of CSII compared to MDI showed a reduction in HbA1c levels of 0.21%; 0.4%; 0.2%; 0.3% and 0.26% in the five selected studies, respectively. Although studies have used different scales to assess events of severe hypoglycemia, the data indicate that CSII may be better than MDI to reduce the incidence of severe hypoglycemic events. No significant difference was found for asymptomatic hypoglycemia, weight gain. Adverse events have not been well reported, there is no information available on mortality, morbidity, and costs.

CONCLUSIONS : The discrete reduction in HbA1c levels associated with CSII use is not considered clinically significant (0.5%). However, there is no consensus on the best minimal clinical difference and lower HbA1c reduction. The circumstances surrounding the use of this type of device should be considered, among them: uncertainties about results, subjectivity in its choice for the patient, continuous evolution of this technology, quality of life, cost-effectiveness, and budget impact.