Diabetes Treatment Review

Insulin pump therapy

Martin Gilmour of the Diabetic Hypoglycemia Editorial Team

Diabetic Hypoglycemia September 2008, Volume 1, Issue 2: page 17-18

Abstract

The ideal insulin replacement therapy should replicate normal pancreatic function as closely as possible. Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) is now an established treatment, allowing patients to manage their diabetes intensively and optimize glycemic control.

This issue’s treatment review focuses on recent publications on the use of insulin pump therapy in diabetes. A review by White offers comprehensive guidance on the use of CSII in diabetes patients, emphasizing the importance of a good treatment plan. In another review, Pickup and Renard discuss whether long-acting insulin analogs can replace the need for CSII in type 1 and type 2 diabetes patients , suggesting that CSII is still the best therapeutic option in some type 1 diabetes patients.

The treatment review also summarizes NICE guidance on insulin pump therapy, issued in July 2008. The guidelines recommend insulin pump therapy for adults with ‘difficult to control’ type 1 diabetes, and for children under 12 years with type 1 diabetes if their daily injection therapy is impractical or inappropriate. NICE recommends continuation of CSII therapy in these patient groups only if it results in an improvement in glycemic control, or a sustained decrease in the rate of hypoglycemic episodes. NICE does not recommend CSII for the treatment of people with type 2 diabetes.

Keywords: insulin pump therapy, continuous subcutaneous insulin infusion, diabetes