Insulin pump therapy, should we consider it more often?

Erratic blood glucose control, hypoglycaemia unawareness and optimisation of glycaemic control during pregnancy are widely recognised indications for commencing diabetic patients on continuous subcutaneous insulin infusion (CSII) using an insulin pump. In patients without such a specific condition, the benefit of CSII over other forms of intensified treatment on glycaemic control and hypoglycaemic rate is generally viewed as too modest to warrant a change of regimen. However, the impact of the treatment regimen on psychosocial parameters is often undervalued, at least in randomised trials. This is unfortunate as quality of life and treatment satisfaction probably determine the patient's preferences more than metabolic parameters. To truly appreciate all potential benefits of either strategy (CSII or injection therapy), these data are urgently required. In the meantime, doctors should keep an open eye for the specific needs of the individual patient to find the best treatment available for that person.