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

CSII (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.