Continuous subcutaneous insulin infusion therapy: A primer on insulin pumps.
OBJECTIVE
To summarize the role, benefits, and risks of continuous subcutaneous insulin infusion (CSII) therapy for treating diabetes.


METHODS
A literature search was conducted in Medline (1996 to July 2008) using the search terms intensive insulin therapy, insulin pump, and continuous subcutaneous insulin infusion. Reference lists from comprehensive review articles were also used to identify additional original research publications.


METHODS
Review articles and studies evaluating the role, benefits, and risks of CSII.


RESULTS
More than 300,000 individuals use CSII to treat diabetes. Many experts believe that CSII is the best insulin delivery method for highly motivated patients with type 1 diabetes who are technologically savvy and have the means to pay for the device and infusion sets. CSII is also useful for patients with type 2 diabetes who require multiple daily injections and experience wide fluctuations in blood glucose throughout the day or who experience severe hypoglycemia. A variety of CSII systems are currently available. All CSII systems provide precise insulin delivery throughout the day and improve the accuracy of bolus dose calculations, thereby achieving improved glycemic control with less frequent and severe hypoglycemic episodes. Patients who choose CSII report improved quality of life. Potential risks associated with CSII include mechanical problems leading to diabetes ketoacidosis, infections at the infusion site, hypoglycemia, and lipodystrophy.


CONCLUSIONS
CSII is an attractive treatment option for many patients with diabetes. Given the widespread use of CSII, all health professionals should be familiar with the basic features of insulin pump technology, the potential risks and benefits of CSII, and how to troubleshoot common problems.
Potti
Lakshmi G
LG
Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, USA.
Haines
Stuart T
ST
D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D011788:Quality of Life
D007004:Hypoglycemic Agents; D007328:Insulin