Continuous subcutaneous insulin infusion (CSII) has been used for 25 years to achieve strict blood glucose control in selected patients with type 1 diabetes. Noting that its worldwide use is increasing, British diabetes experts reviewed the evidence to justify its increased use.

They found that in most cases, CSII therapy provides similar or slightly lower mean blood glucose concentrations and HbA1c measurements than multiple insulin injections. Hypoglycemia is, however, markedly less frequent in CSII. Insulin pumps also improve nighttime glycemic control, and their automatic basal rate changes help to minimize the "dawn phenomenon," a pre-breakfast blood glucose increase that is often seen with injection therapy.

These specialists suggest that the principal indications for CSII should be frequent, unpredictable hypoglycemia or a marked dawn phenomenon that persists after attempts to improve control with intensive insulin injection regimens. They note that candidates for CSII must be motivated, willing and able to undertake pump therapy and adequately psychologically stable.

Related information Treatment - Insulin

Source:  Pickup J, Keen H. Continuous subcutaneous insulin infusion at 25 years - evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care, March 2002;25(3):593-598. (Abs.)