Review: Use of continuous subcutaneous insulin infusion in special populations and circumstances in patients with type 1 diabetes

Abstract

CSII (continuous subcutaneous insulin infusion) is a valuable therapeutic option for many patients with type 1 diabetes, specifically where hyperglycaemia or recurrent hypoglycaemia persist during MDI (multiple daily injection) therapy. Special situations under which the use of CSII requires consideration include pregnancy, surgery and exercise. There is no evidence that CSII and MDI therapy differ significantly in efficacy in relation to maternal or foetal outcomes. Accordingly, NICE (National Institute for Health and Clinical Excellence) recommends that pregnant women with insulin-treated diabetes should be offered CSII using the same criteria as the general population. While continuous intravenous insulin infusion may offer advantages over MDI in patients with diabetes undergoing surgery, the role of CSII is unclear. During sports, CSII can facilitate better glycaemic control by allowing the precise adjustment of the basal rate and the administration of small incremental doses, and this may be complemented by the use of CGM (continuous glucose monitoring). More generally, real-time CGM can substantially improve glycaemic control in poorly controlled patients and, using sensor alarms, reduce hyperglycaemia and hypoglycaemia, although the clinical role of this technology is not well defined. Further research should evaluate the potential value of CSII in other populations and clinical scenarios.