Long-term use of continuous subcutaneous insulin infusion

Abstract 

The routine clinical use of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) is very variable throughout the world – from 20% to less than 1% of type 1 diabetic subjects. One reason for this is the continued confusion about its best use. Here, I suggest that the main indications are frequent unpredictable hypoglycaemia, and the combination of an elevated HbAlc and high blood glucose variability, in spite of best attempts to improve control with multiple daily insulin injections (MDI). The largest improvements in HbAlc on switching from MDI to CSII are seen in the worst controlled patients on injections, and thus when insulin pump therapy is used in this target group it is more effective then previously thought and likely to deliver a major reduction in the risk of developing microvascular disease.

Keywords:  Type 1 diabetes , Insulin pump therapy , Continuous subcutaneous insulin infusion , Intensified insulin therapy , Micovascular disease , HbAlc

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