Subcutaneous Insulin Pump

Abstract

Over the last 20 years, continuous subcutaneous insulin infusion (CSII) has become a viable alternative to multiple daily insulin injections (MDI) in type 1 diabetic patients. Both randomized controlled trials and observational studies have found lower glycated hemoglobin (HbA 1c ) levels, less severe hypoglycemic episodes, smaller blood glucose fluctuations, and a better quality of life in CSII-treated adult patients with type 1 diabetes in comparison to MDI treatment. CSII requires care by skilled professionals, careful selection of patients, meticulous patient monitoring, and thorough patient education. Although obviously more expensive than MDI, CSII may be cost-effective when elevated HbA 1c levels or continued disabling hypoglycemia persist despite optimized MDI therapy. More recently, sensor-augmented pumps (SAPs) have become available. These combine the technology of an insulin pump with a continuous glucose sensor. The best results with SAPs can be expected in patients who use the glucose sensor frequently, draw adequate conclusions from the data, and make immediate therapeutic decisions. Randomized controlled studies have provided evidence that SAPs can improve HbA 1c without increasing severe hypoglycemic episodes in patients with type 1 diabetes with elevated baseline HbA 1c , and that the frequency and duration of hypoglycemic events can be reduced in patients with satisfactory baseline HbA 1c , increasing treatment satisfaction. © 2015 S. Karger AG, BaselThe first insulin pump prototype, devised by Arnold Kadish in 1963, was a very large device worn as a backpack that delivered glucagon and insulin. A handier version was developed by Dean Kamen in the late 1970s. Early portable pumps were large and quite complicated to use. They offered a single basal rate, plus a stepped-up rate of infusion to cover meals. Insulin was delivered through a nylon cannula implanted in

Improved Postprandial Glycemic Control with Faster-Acting Insulin Aspart in Patients with Type 1 Diabetes Using Continuous Subcutaneous Insulin Infusion

“…10,13 Improvements in the compatibility of RAIAs versus buffered regular human insulin 14 and developments in sensor and pump technology have contributed to increased use of CSII. 15 The T1D Exchange clinic registry of 28,000 US citizens with type 1 diabetes reports that 60% of participants use CSII, which equates to a rise of 4% over a 15-month data collection period (commencing in September 2013). 16 …”

A qualitative study exploring patients’ experiences regarding insulin pump use

“…Technological advances over the years have turned insulin pumps into a practical alternative to multiple daily injections (MDIs), since pager-sized pumps (e.g. OneTouch and MiniMed Paradigm) have taken the place of the brick-sized old ones (Alsaleh et al, 2010, Lepore and Tommaselli, 2015).…”

“…Insulin pumps have been shown to be cost-effective in patients with poorly controlled type 2 diabetes despite therapy optimisation (Roze et al, 2016). Furthermore, the physiological continuous delivery of insulin via a pump provides better glycaemic control with less insulin usage and thus fewer side effects (less weight gain and hypoglycaemic events), which subsequently improves patients’ quality of life and wellbeing (Lepore and Tommaselli, 2015). Studies examining the use of these devices in the management of patients with type 2 diabetes are scarce.…”