Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Reviews/Commentaries/Position Statements

Continuous Subcutaneous Insulin Infusion at 25 Years

Evidence base for the expanding use of insulin pump therapy in type 1 diabetes

  1. John Pickup, DPHIL, FRCPATH and
  2. Harry Keen, CBE, MD, FRCP
  1. From the Department of Chemical Pathology and Metabolic Unit, Guy’s King’s and St Thomas’ Hospitals School of Medicine, Guy’s Hospital, London, U.K.
    Diabetes Care 2002 Mar; 25(3): 593-598. https://doi.org/10.2337/diacare.25.3.593
    PreviousNext
    • Article
    • Info & Metrics
    • PDF
    Loading

    Evidence base for the expanding use of insulin pump therapy in type 1 diabetes

    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.

    • CSII, continuous subcutaneous insulininfusion
    • DCCT, Diabetes Control and Complications Trial

    Footnotes

    • Address correspondence and reprint requests to John Pickup, Metabolic Unit, GKT School of Medicine, Guy’s Hospital, London SE1 9RT, U.K. E-mail: john.pickup{at}kcl.ac.uk.

      Received for publication 29 June 2001 and accepted in revised form 15 November 2001.

      J.P. has received funds from MiniMed to support studies concerning insulin pump therapy.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • DIABETES CARE
    View Full Text
    PreviousNext
    Back to top
    Diabetes Care: 25 (3)

    In this Issue

    March 2002, 25(3)
    • Table of Contents
    • About the Cover
    • Index by Author
    Sign up to receive current issue alerts
    View Selected Citations (0)
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word about Diabetes Care.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Continuous Subcutaneous Insulin Infusion at 25 Years
    (Your Name) has forwarded a page to you from Diabetes Care
    (Your Name) thought you would like to see this page from the Diabetes Care web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Continuous Subcutaneous Insulin Infusion at 25 Years
    John Pickup, Harry Keen
    Diabetes Care Mar 2002, 25 (3) 593-598; DOI: 10.2337/diacare.25.3.593

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Add to Selected Citations
    Share

    Continuous Subcutaneous Insulin Infusion at 25 Years
    John Pickup, Harry Keen
    Diabetes Care Mar 2002, 25 (3) 593-598; DOI: 10.2337/diacare.25.3.593
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Abstract
      • CONTROLLED TRIALS COMPARING GLYCEMIC CONTROL DURING CSII VERSUS INTENSIVE INSULIN INJECTION REGIMENS
      • HYPOGLYCEMIA: A POSSIBLE SIDE EFFECT OF CSII OR A CLINICAL INDICATION FOR PUMP THERAPY?
      • DIABETIC KETOACIDOSIS
      • MANAGEMENT OF THE DAWN PHENOMENON BY CSII
      • DIABETIC SUBJECTS WHO MAY BE UNSUITABLE FOR CSII
      • ESTABLISHING GUIDELINES FOR THE USE OF CSII
      • CONCLUSIONS
      • Footnotes
      • References
    • Info & Metrics
    • PDF

    Related Articles

    Cited By...

    More in this TOC Section

    • Managing Preexisting Diabetes for Pregnancy
    • Third Annual World Congress on the Insulin Resistance Syndrome
    • Third Annual World Congress on the Insulin Resistance Syndrome
    Show more Reviews/Commentaries/Position Statements

    Similar Articles

    Navigate

    • Current Issue
    • Standards of Care Guidelines
    • Online Ahead of Print
    • Archives
    • Submit
    • Subscribe
    • Email Alerts
    • RSS Feeds

    More Information

    • About the Journal
    • Instructions for Authors
    • Journal Policies
    • Reprints and Permissions
    • Advertising
    • Privacy Policy: ADA Journals
    • Copyright Notice/Public Access Policy
    • Contact Us

    Other ADA Resources

    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • Scientific Sessions Abstracts
    • Standards of Medical Care in Diabetes
    • BMJ Open - Diabetes Research & Care
    • Professional Books
    • Diabetes Forecast

     

    • DiabetesJournals.org
    • Diabetes Core Update
    • ADA's DiabetesPro
    • ADA Member Directory
    • Diabetes.org

    © 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.