Insulin Pumps

  • John C. PickupEmail author
Reference work entry
Part of the Endocrinology book series (ENDOCR)


Insulin pump therapy (continuous subcutaneous insulin infusion, CSII) is a form of intensified insulin treatment involving subcutaneous infusion of short-acting insulin from a portable pump. There is a well-established evidence base for the effectiveness of CSII in type 1 diabetes, which includes reduction in HbA1c, blood glucose variability, and all grades of hypoglycemia compared to MDI, but more research is needed on how new long-acting insulin preparations and more effective diabetes education will reduce the number who do not achieve target levels of control on MDI and who are thus candidates for CSII. Insulin pump therapy is an affordable, cost-effective therapeutic option for most healthcare settings. There is an increasing role for CSII in patients with poorly controlled type 2 diabetes who are not adequately managed on MDI, but smaller, cheaper, and simpler “patch” pumps are likely to be needed to make insulin pump therapy cost-effective in this type of diabetes.


Insulin pump therapy Continuous subcutaneous insulin infusion CSII Type 1 diabetes Type 2 diabetes Hypoglycemia Glycemic control Intensified insulin therapy 


  1. Aberle I, Scholz U, Bach-Kliegel B, Fischer C, Gorny M, Langer K, Kliegel M. Psychological aspects in continuous subcutaneous insulin infusion: a retrospective study. J Psychol. 2009;14:147–60.CrossRefGoogle Scholar
  2. Bergenstal RM, Klonoff DC, Garg SK, Bode BW, Meredith M, Slover RH, Ahmann AJ, Welsh JB, Lee SW, Kaufman FR, ASPIRE In-Home Study Group. Threshold-based insulin-pump interruption for reduction of hypoglycemia. NEJM. 2013;369:224–32.CrossRefGoogle Scholar
  3. Choudhary P, Shin J, Wang Y, Evans ML, Hammond PJ, Kerr D, Shaw JA, Pickup JC, Amiel SA. Insulin pump therapy with automated insulin suspension in response to hypoglycemia: reduction in nocturnal hypoglycemia in those at greatest risk. Diabetes Care. 2011;34:2023–5.CrossRefGoogle Scholar
  4. Choudhary P, Ramasamy S, Green L, Gallen G, Pender S, Brackenridge A, Amiel SA, Pickup JC. Real-time continuous glucose monitoring reduces severe hypoglycemia in hypoglycemia-unaware patients with type 1 diabetes. Diabetes Care. 2013;36:4160–2.CrossRefGoogle Scholar
  5. Cobry E, McFann K, Messer L, Gage V, VanderWel B, Horton L, Chase PH. Timing of meal insulin boluses to achieve optimal postprandial glycemic control in patients with type 1 diabetes. Diabet Technol Ther. 2010;12:173–7.CrossRefGoogle Scholar
  6. de Vries L, Grushka Y, Lebenthal Y, Shalitin S, Phillip M. Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes. Pediatr Diabetes. 2011;12:506–12.CrossRefGoogle Scholar
  7. DeVries JH, Snoek FJ, Kostense PJ, Masurel N, Heine RJ. A randomized trial of continuous subcutaneous insulin infusion and intensive injection therapy in type 1 diabetes for patients with long-standing poor glycemic control. Diabetes Care. 2002;25:2074–80.CrossRefGoogle Scholar
  8. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. NEJM. 1993;329:977–86.CrossRefGoogle Scholar
  9. Edelman S, Bode BW, Bailey TS, Kipnes MS, Brunelle R, Chen X, Frias JP. Insulin pump therapy in patients with type 2 diabetes. Safely improved glycemic control using a simple insulin dosing regimen. Diabet Technol Ther. 2010;12:627–33.CrossRefGoogle Scholar
  10. Grunberger G, Abelseth J, Bailey T, Bode B, Handelsman Y, Hellman R, Jovanovič L, Lane W, Raskin P, Tamborlane W, Rothermel C. Consensus statement by the American Association of Clinical Endocrinologists/American College of Endocrinology Insulin Pump Management Task Force. Endocr Pract. 2014;20:463–89.CrossRefGoogle Scholar
  11. Jones SM, Quarry JL, Caldwell-McMillan M, Mauger DT, Gabbay RA. Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. Diabet Technol Ther. 2005;7:233–40.CrossRefGoogle Scholar
  12. Koivisto VA, Yki-Järvinen H, Helve E, Pelkonen R. Pathogenesis and prevention of the dawn phenomenon in diabetic patients treated with CSII. Diabetes. 1986;35:78–82.CrossRefGoogle Scholar
  13. Kordonouri O, Hartmann R, Danne T. Treatment of type 1 diabetes in children and adolescents using modern insulin pumps. Diabetes Res Clin Pract. 2011;93(Suppl):S118–24.CrossRefGoogle Scholar
  14. Laimer M, Melmer A, Mader JK, Schütz-Fuhrmann I, Engels H-R, Götz G, Pfeifer M, Hermann JM, Stettler C, Holl RW. Variability of basal rate profiles in insulin pump therapy and association with complications in type 1 diabetes mellitus. PLoS One. 2016;11(3):e0150604. Scholar
  15. Lauritzen T, Pramming S, Deckert T, Binder C. Pharmacokinetics of continuous subcutaneous insulin infusion. Diabetologia. 1983;24:326–9.CrossRefGoogle Scholar
  16. Leinung M, Thompson S, Mingfrei Luo PA-C, Leykina L, Nardacci E. Use of insulin pump therapy in patients with type 2 diabetes after failure of multiple daily injections. Endocr Pract. 2013;19:9–13.CrossRefGoogle Scholar
  17. Ly TT, Nicholas JA, Retterath A, Lim EM, Davis EA, Jones TW. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013;310:1240–7.CrossRefGoogle Scholar
  18. McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35:1897–901.CrossRefGoogle Scholar
  19. Misso ML, Egberts KJ, Page M, O’Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010;(1):Art. No.: CD005103.
  20. Morera J, Joubert M, Morello R, Rod A, Lireux B, Reznik Y. Sustained efficacy of insulin pump therapy in type 2 diabetes: 9-year follow-up in a cohort of 161 patients. Diabetes Care. 2016;39:e74–5.CrossRefGoogle Scholar
  21. Mukhopadhyay A, Fraser RB, Bolarinde O. Continuous subcutaneous insulin infusion vs. intensive conventional insulin therapy in pregnant diabetic women: a systematic review and meta-analysis of randomized, controlled trials. Am J Obstet Gynecol. 2007;197:447–56.CrossRefGoogle Scholar
  22. National Institute for Health and Care Excellence. Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. In: Technology appraisal guidance 151 (review of technology appraisal guidance 57). London, UK: NICE; 2008.Google Scholar
  23. Nixon R, Folwell R, Pickup JC. Variations in the quality and sustainability of long-term glycaemic control with continuous subcutaneous insulin infusion. Diabet Med. 2014;31:1174–7.CrossRefGoogle Scholar
  24. Olinder AL, Kernell A, Smide B. Missed bolus doses: devastating for metabolic control in CSII-treated adolescents with type 1 diabetes. Pediatr Diabetes. 2009;10:142–8.CrossRefGoogle Scholar
  25. Parkner T, Laursen T, Vestergaard ET, Hartvig H, Smedegaard JS, Lauritzen T, Christiansen JS. Insulin and glucose profiles during continuous subcutaneous insulin infusion compared with injection of a long-acting insulin in type 2 diabetes. Diabet Med. 2008;25:585–91.CrossRefGoogle Scholar
  26. Perkins BA, Ridell MC. Type 1 diabetes and exercise: using the insulin pump to maximum advantage. Can J Diabet. 2006;30:72–9.CrossRefGoogle Scholar
  27. Pickup JC. Insulin-pump therapy for type 1 diabetes mellitus. NEJM. 2012;366:1616–24.CrossRefGoogle Scholar
  28. Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in type 1 diabetes: meta-analysis of multiple daily insulin injections versus continuous subcutaneous insulin infusion. Diabet Med. 2008;25:765–74.CrossRefGoogle Scholar
  29. Pickup JC, Keen H, Parsons JA, Alberti KGMM. Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. BMJ. 1978;i:204–7.CrossRefGoogle Scholar
  30. Pickup JC, Mattock MB, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared to intensive insulin injection therapy in type 1 diabetes: meta-analysis of randomised controlled trials. BMJ. 2002;324:705–8.CrossRefGoogle Scholar
  31. Pickup JC, Kidd J, Burmiston S, Yemane N. Effectiveness of continuous subcutaneous insulin infusion in hypoglycaemia-prone type 1 diabetes: implications for NICE guidelines. Pract Diabet Int. 2005;22:10–4.CrossRefGoogle Scholar
  32. Pickup JC, Kidd J, Burmiston S, Yemane N. Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability. Diabet Metab Res Rev. 2006;22:232–7.CrossRefGoogle Scholar
  33. Pickup JC, Yemane N, Brackenridge A, Pender S. Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diabet Technol Ther. 2014;16:145–9.CrossRefGoogle Scholar
  34. Pozzilli P, Battelino T, Danne T, Hovorka R, Jarosz-Chobot P, Renard E. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics. Diabetes Metab Res Rev. 2016;32:21–39.CrossRefGoogle Scholar
  35. Quirόs C, Giménez M, Ríos R, Careaga M, Roca D, Vidal M, Conget I. Long-term outcome of insulin pump therapy: reduction of hypoglycaemia and impact on glycaemic control. Diabet Med. 2016;33:1422. Scholar
  36. Raskin P, Bode BW, Marks JB, Hirsch IB, Weinstein RL, McGill JB, Peterson GE, Mudaliar SR, Reinhardt RR. Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally effective in type 2 diabetes: a randomized, parallel-group, 24-week study. Diabetes Care. 2003;26:2598–603.CrossRefGoogle Scholar
  37. Retnakaran R, Hochman J, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V, Zinman B. Continuous subcutaneous insulin infusion versus multiple daily injections. The impact of baseline A1c. Diabetes Care. 2004;27:2590–6.CrossRefGoogle Scholar
  38. Reznik Y, Cohen O, Aronson R, Conget I, Runzis S, Castaneda J, Scott W Lee. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. The Lancet. 2014;384(9950):1265–1272.CrossRefGoogle Scholar
  39. Roze S, Smith-Palmer J, Valentine W, de Portu S, Nørgaard K, Pickup JC. Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in type 1 diabetes: a systematic review. Diabet Med. 2015;32:1415–24.CrossRefGoogle Scholar
  40. Sherr JL, Hermann JM, Campbell F, Foster NC, Hofer SE, Allgrove J, Maahs DM, Kapellen TM, Holman N, Tamborlane WV, Holl RW, Beck RW, Warner JT, T1D Exchange Clinic Network, DPV Initiative, National Paediatric Diabetes Audit, Royal College of Paediatrics and Child Health registries. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries. Diabetologia. 2016;59:87–91.CrossRefGoogle Scholar
  41. Steineck I, Cederholm J, Eliasson B, Rawshani A, Eeg-Olofsson K, Svensson A-M, Zethelius B, Avdic T, Landin-Olsson M, Jendle J, Gudbjörnsdóttir S, the Swedish National Diabetes Register. Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study. BMJ. 2015;350:h3234.CrossRefGoogle Scholar
  42. Tamborlane WV, Sherwin RS, Genel M, Felig P. Reduction to normal of plasma glucose in juvenile diabetes by subcutaneous administration of insulin with a portable infusion pump. NEJM. 1979;300:573–8.CrossRefGoogle Scholar
  43. Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, Yerushalmy Y, Raz I, Harman-Boehm I. Insulin pump therapy vs. multiple daily injections in obese type 2 diabetic patients. Diabet Med. 2005;22:1037–46.CrossRefGoogle Scholar
  44. Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy. A meta-analysis. Diabetes Care. 2003;26:1079–87.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and MedicineKing’s College London, Guy’s HospitalLondonUK

Personalised recommendations