Review Article

Continuous subcutaneous insulin infusion (CSII) 30 years later: still the best option for insulin therapy

  1. Daniela Bruttomesso1,*,
  2. Silvana Costa1,
  3. Aldo Baritussio2

Article first published online: 26 JAN 2009

DOI: 10.1002/dmrr.931

Issue

Diabetes/Metabolism Research and Reviews

Diabetes/Metabolism Research and Reviews

Volume 25, Issue 2, pages 99–111, February 2009

Additional Information

How to Cite

Bruttomesso, D., Costa, S. and Baritussio, A. (2009), Continuous subcutaneous insulin infusion (CSII) 30 years later: still the best option for insulin therapy. Diabetes Metab. Res. Rev., 25: 99–111. doi: 10.1002/dmrr.931

Author Information

  1. 1

    Department of Clinical and Experimental Medicine, Division of Metabolic Diseases, University of Padova, Padova, Italy

  2. 2

    Department of Medical and Surgical Sciences, University of Padova, Padova, Italy

*Cattedra di Malattie del Metabolismo, Policlinico Universitario, Via Giustiniani, 2, 35128 Padova, Italy.

Publication History

  1. Issue published online: 13 FEB 2009
  2. Article first published online: 26 JAN 2009
  3. Manuscript Accepted: 30 NOV 2008
  4. Manuscript Revised: 22 OCT 2008
  5. Manuscript Received: 11 JUL 2008

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Keywords:

  • continuous subcutaneous insulin infusion;
  • diabetes mellitus;
  • insulin analogues

Abstract

Thirty years after its introduction, the use of continuous subcutaneous insulin infusion (CSII) keeps increasing, especially among children and adolescents. The technique, when used properly, is safe and effective.

Compared with traditional NPH-based multiple daily injections (MDI), CSII provides a small but clinically important reduction of HbA1c levels, diminishes blood glucose variability, decreases severe hypoglycaemic episodes and offers a better way to cope with the dawn phenomenon.

Insulin analogues have improved the treatment of diabetes, eroding part of the place previously occupied by CSII, but CSII still remains the first option for patients experiencing severe hypoglycaemic episodes, high HbA1c values or marked glucose variability while being treated with optimized MDI. Furthermore CSII is better than MDI considering the effects on quality of life and the possibility to adjust insulin administration according to physical activity or food intake.

CSII may be limited by cost. Present estimates suggest that CSII may be cost-effective just for patients experiencing a marked improvement in HbA1c or a decrease in severe hypoglycaemic episodes, but the effects on quality of life are difficult to measure.

CSII does not merely imply wearing an external device; it requires a multidisciplinary team, intensive patient education and continuous follow up. Copyright © 2009 John Wiley & Sons, Ltd.

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