Continuous Subcutaneous Insulin Infusion Therapy with Rapid-ActingInsulin Analogs in Insulin Pumps: Does it Work, How Does it Work, andwhat Therapies Work Better than Others?

Many patients are not optimally controlled on conventional insulin regimens. This review evaluates the practicalities and clinical success of continuous subcutaneous insulin infusion therapy with rapid-acting insulin analogs in insulin pumps in patients with type 1 and type 2 diabetes. In contrast to a multiple daily injection regimen, CSII provides patients with greater flexibility in the timing of meals and insulin dosing, resulting in improved quality of life and greater treatment adherence. CSII therapy with rapid-acting insulin analogs offers reliable glycemic control and proactive response to glucose variability, with a reduced risk of weight gain and hypoglycemia compared with regular human insulin in CSII. While the clinical benefits of CSII versus multiple daily injection therapy in patients with type 1 diabetes are quite evident in studies in appropriately-selected patients, the benefits are more equal in patients with type 2 diabetes. Appropriate patient selection for CSII therapy may help ensure successful outcomes in diabetes treatment. Patients who are very poorly controlled on multiple daily injections may benefit from CSII therapy, with the greatest glycemic improvement associated with high baseline HbA1c levels. CSII therapy may be of particular benefit to patients with type 1 diabetes who are prone to hypoglycemia and patients with type 2 diabetes who are obese and uncontrolled on high doses of insulin; however, most important as a predictor of success is that patients desire CSII therapy.