Continuous Subcutaneous Insulin Infusion at 25 Years
Open Access
- 1 March 2002
- journal article
- review article
- Published by American Diabetes Association in Diabetes Care
- Vol. 25 (3), 593-598
- https://doi.org/10.2337/diacare.25.3.593
Abstract
Continuous subcutaneous insulin infusion (CSII) is used in selected type 1 diabetic subjects to achieve strict blood glucose control. A quarter of a century after its introduction, world-wide use of CSII is increasing. We review the evidence base that justifies this increase, including effectiveness compared with modern intensified insulin injection regimens and concern about possible complications. Review of controlled trials shows that, in most patients, mean blood glucose concentrations and glycated hemoglobin percentages are either slightly lower or similar on CSII versus multiple insulin injections. However, hypoglycemia is markedly less frequent than during intensive injection therapy. Ketoacidosis occurs at the same rate. Nocturnal glycemic control is improved with insulin pumps, and automatic basal rate changes help to minimize a prebreakfast blood glucose increase (the “dawn phenomenon”) often seen with injection therapy. Patients with “brittle” diabetes characterized by recurrent ketoacidosis are often not improved by CSII, although there may be exceptions. We argue that explicit clinical indications for CSII are helpful; we suggest the principal indications for health service or health insurance–funded CSII should include frequent, unpredictable hypoglycemia or a marked dawn phenomenon, which persist after attempts to improve control with intensive insulin injection regimens. In any circumstances, candidates for CSII must be motivated, willing and able to undertake pump therapy, and adequately psychologically stable. Some diabetic patients with well-defined clinical problems are likely to benefit substantially from CSII and should not be denied a trial of the treatment. Their number is relatively small, as would therefore be the demand on funds set aside for this purpose.Keywords
This publication has 58 references indexed in Scilit:
- Organising and running a pump service in The NetherlandsPractical Diabetes International, 2001
- Continuous subcutaneous insulin infusion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes.Diabetes Care, 1999
- Comparison of Continuous Subcutaneous Insulin Infusion with Multiple Insulin Injections Using the NovoPenDiabetic Medicine, 1988
- Effect of near normoglycaemia for two years on progression of early diabetic retinopathy, nephropathy, and neuropathy: the Oslo study.BMJ, 1986
- Pathogenesis of the Dawn Phenomenon in Patients with Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1985
- Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patientsPublished by American Medical Association (AMA) ,1984
- Intermediate acting insulin given at bedtime: effect on blood glucose concentrations before and after breakfast.BMJ, 1983
- Clinical Use of the Insulin Infusion Pump in 100 Patients with Type I DiabetesNew England Journal of Medicine, 1982
- The Dawn Phenomenon, an Early Morning Glucose Rise: Implications for Diabetic Intraday Blood Glucose VariationDiabetes Care, 1981
- Reduction to Normal of Plasma Glucose in Juvenile Diabetes by Subcutaneous Administration of Insulin with a Portable Infusion PumpNew England Journal of Medicine, 1979