title: Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics.
abstract: The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
authors: Area of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
authors: Paolo
authors: P
authors: Pozzilli
authors: Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors: Tadej
authors: T
authors: Battelino
authors: Diabetes Centre for Children and Adolescents, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany.
authors: Thomas
authors: T
authors: Danne
authors: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
authors: Roman
authors: R
authors: Hovorka
authors: Department of Pediatrics, Endocrinology and Diabetes School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors: Przemyslawa
authors: P
authors: Jarosz-Chobot
authors: Department of Endocrinology, Diabetes, Nutrition and CIC INSERM 1411, Montpellier University Hospital, Montpellier, France.
authors: Eric
authors: E
authors: Renard
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D016494:Computer Security; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005060:Europe; D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D055104:Infusions, Subcutaneous; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics / Q000639:trends; D061266:Insulin, Short-Acting / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D061385:Insulins / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018670:Monitoring, Ambulatory; D057285:Precision Medicine; D011788:Quality of Life
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D061266:Insulin, Short-Acting; D061385:Insulins
keywords: continuous subcutaneous insulin infusion; diabetes mellitus; paediatric; pharmacoeconomics; pregnancy; rapid-acting insulin analogue