Intraperitoneal Therapy Superior to multiple insulin injections in Early Diabetic Nephropathy: Study

The comparative efficacy and safety of insulin pump (IP) therapy versus multiple subcutaneous insulin injections (MSIIs) in patients with early-stage diabetic nephropathies (DNs) remain subjects of ongoing clinical debate. This systematic review and meta-analysis aimed to evaluate the differences in renal function, glycemic control, and safety outcomes between IP therapy and MSII in patients with early-stage DN.

A comprehensive literature search was conducted across Chinese-language databases [China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Data, and Chinese Biomedical Literature Database (CBM)] and English-language databases [National Library of Medicine, USA (PubMed), Web of Science, and Excerpta Medica Database (EMBASE)] from inception to January 2023. Randomized controlled trials comparing IP therapy with MSII in individuals with early-stage DN were included. The methodological quality of the included studies was assessed, and relevant data were extracted for quantitative meta-analysis.

A total of 23 randomized controlled trials met the inclusion criteria. Meta-analysis demonstrated that IP therapy was associated with significant improvements in renal and glycemic indicators: urinary albumin excretion rate: odds ratio (OR) =−2.03, 95% confidence interval (CI): −2.53, −1.52, P<0.001; 24-hour urinary protein volume: OR =−0.96, 95% CI: −1.51, −0.41, P<0.001; β2-microglobulin: OR =−0.68, 95% CI: −0.81, −0.55, P=0.04; renal function: OR =−0.38, 95% CI: −0.77, 0.00, P<0.001; glycated hemoglobin: OR =−0.83, 95% CI: −1.22, −0.43, P<0.001; fasting plasma glucose: OR =−1.76, 95% CI: −2.31, −1.22, P=0.02; 2-hour postprandial glucose: OR =−1.34, 95% CI: −1.64, −1.05, P<0.001. Regarding safety, lower incidences of hypoglycemia (OR =3.43, 95% CI: 1.84–6.39, P=0.98) and blurred vision (OR =2.53, 95% CI: 1.20–5.36, P>0.99) were observed with IP therapy. However, these differences were not statistically significant and the findings should be interpreted cautiously due to high P values and limited event counts.

When compared to MSII, IP therapy demonstrated superior efficacy in improving renal and glycemic parameters in individuals with early-stage DN. Although associated with a reduced incidence of adverse events, potential risks related to IP use should be carefully evaluated during clinical decision-making.

Reference:

Xu, M., Huang, J.-J., Qin, X.-H., & Zhu, S.-Y. (2026). Comparative efficacy and safety of insulin pump versus multiple daily injections in early-stage diabetic nephropathy: A systematic review and meta-analysis. Translational Andrology and Urology, 15(3). https://tau.amegroups.org/article/view/150125

Keywords:

Intraperitoneal, Therapy, Superior, multiple, insulin, injections, Early Diabetic Nephropathy, Study, Diabetic nephropathies (DNs); insulin pump (IP); meta-analysis; multiple subcutaneous insulin injection (MSII), Xu, M., Huang, J.-J., Qin, X.-H., & Zhu, S.-Y