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Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes.
Diabetes Care. 2002 Mar; 25(3):593-8.DC

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.

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Authors+Show Affiliations

Pickup J
Department of Chemical Pathology and Metabolic Unit, Guy's King's and St Thomas' Hospitals School of Medicine, Guy's Hospital, London, UK. john.pickup@kcl.ac.uk
Keen H
No affiliation info available

MeSH

Blood GlucoseClinical Trials as TopicDiabetes Mellitus, Type 1Diabetic KetoacidosisHumansHypoglycemiaInsulin Infusion SystemsPractice Guidelines as Topic

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

11874953

Citation

Pickup, John, and Harry Keen. "Continuous Subcutaneous Insulin Infusion at 25 Years: Evidence Base for the Expanding Use of Insulin Pump Therapy in Type 1 Diabetes." Diabetes Care, vol. 25, no. 3, 2002, pp. 593-8.
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. 2002;25(3):593-8.
Pickup, J., & Keen, H. (2002). Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care, 25(3), 593-8.
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. 2002;25(3):593-8. PubMed PMID: 11874953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes. AU - Pickup,John, AU - Keen,Harry, PY - 2002/3/5/pubmed PY - 2002/5/11/medline PY - 2002/3/5/entrez SP - 593 EP - 8 JF - Diabetes care JO - Diabetes Care VL - 25 IS - 3 N2 - 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. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/11874953/Continuous_subcutaneous_insulin_infusion_at_25_years:_evidence_base_for_the_expanding_use_of_insulin_pump_therapy_in_type_1_diabetes_ L2 - https://diabetesjournals.org/care/article-lookup/doi/10.2337/diacare.25.3.593 DB - PRIME DP - Unbound Medicine ER -