Review: The pros and cons of continuous subcutaneous insulin infusion (CSII) therapy in the paediatric population and practical considerations when choosing and initiating CSII in children

Abstract

C SII (continuous subcutaneous insulin infusion), has the potential to improve long-term glycaemic control in many patients with type 1 diabetes. CSII may also reduce the incidence of hypoglycaemic episodes, especially in patients prone to hypoglycaemia, and may reduce glycaemic variability. A pivotal advantage of CSII over MDIs (multiple daily injection), especially in children, is its superior convenience and flexibility. Programmable basal rates are delivered automatically and with unprecedented precision, while bolus doses can easily be used to titrate insulin exposure around meals and activities and to correct hyperglycaemia. The subcutaneous cannula needs to be re-sited only once every 2-3 days. In light of these advantages, CSII is generally preferred by children and parents. Careful patient selection is crucial, however, as CSII users and their carers must be willing and able to use the equipment correctly, as well as to perform general aspects of intensive self-care. Accordingly, CSII should be initiated only by a specialist, multidisciplinary team and in conjunction with a structured, ongoing educational and monitoring programme. Factors affecting the selection of a particular pump include the size and weight of the device, ease of use, range of dose modes and increments, cost, warranty and customer services. Br J Diabetes Vasc Dis 2008; 8(Suppl 1): S6-10

NICE 2008 guidelines on continuous subcutaneous insulin infusion therapy and their impact on management of specific patient populations

“…2 Dr Fiona Campbell (Leeds, UK) outlines the pros and cons of CSII therapy in the paediatric population and the practical considerations when choosing and initiating CSII in children. 3 Finally, Dr Peter Hammond (Harrogate, UK) discusses the use of CSII during pregnancy, surgery and exercise, and the associated role of continuous glucose monitoring. 4 The new NICE guidelines are an important step forward in diabetes care.…”

Insulin Pump Therapy Issues Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Retrospective Study

“…This management was introduced > 40 years ago and is still widely used globally for T1DM patients with well-defined clinical problems who must be interested, keen and able to undergo this therapy [ 3 ]. A crucial advantage of CSII compared to MDIs (multiple daily injection), especially in children, is its superior ease and flexibility [ 4 ]. Programmable basal rates are delivered routinely and with unparalleled precision, while bolus doses can be used effortlessly to regulate insulin exposure around meals and activities and to correct hyperglycaemia [ 4 ].…”

“…A crucial advantage of CSII compared to MDIs (multiple daily injection), especially in children, is its superior ease and flexibility [ 4 ]. Programmable basal rates are delivered routinely and with unparalleled precision, while bolus doses can be used effortlessly to regulate insulin exposure around meals and activities and to correct hyperglycaemia [ 4 ]. Among its major disadvantages are risk for ketoacidosis, infection at the infusion site and relatively higher cost compared to other insulin treatments [ 5 ].…”

The Benefits of Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes

“…CSII therapy is designed to mimic physiological insulin exposure by delivering a daily basal rate while giving extra insulin for carbohydrate intake. The aim of CSII is to improve glycemic control while optimizing the flexibility of therapy (Campbell, 2008).…”