Authors' objectives:

To review the available evidence on continuous subcutaneous infusion of insulin with portable pump in diabetes type I patients.

Authors' recommendations: Continuous subcutaneous external infusion insulin pumps were found to be effective to achieve good metabolic control, the closest to normal, in type I diabetes patients. However, pumps do not conclusively offer a better metabolic control than intensive schedules with multiple injections. Pumps are 'an alternative' to the treatment with multiple injections. The patients' motivation and commitment is one of the most relevant factors to achieve the metabolic (nearly normal glycemia levels and glycosylated hemoglobin) and therapeutical (delay of the onset or slow progression of microvascular complications) objectives, toghether with compliance with the intensive schedule. The patients' own characteristics (education level, coming to terms with the disease expectations, etc.), diabetic education and support from specially trained professionals, may contribute to achieve these objectives and to minimise complications. There seems to be no consistent data defining special characteristics in type I diabetes patients that would make them eligible for this therapeutical option, other than those established in the intensive treatment schedules with insulin. To some authors, those patients who do not achieve the established therapeutical objective with the intensive treatment with multiple injections are the cases where pump may prove most useful. Pumps allow for greater flexibility regarding meal times or in case of frequent travelling in patients with intensive schedules. This potential higher degree of comfort in the lifestyle is countered by a higher risk of complications (hypoglycemia, ketoacidosis, skin infections), some of them common to any intensive schedule, but others specific of pump treatments. It is important to note the high expenditure of research devoted by society to research, cure and treatment of diabetes, as well as the services covered by the public health care insurance system, and the inequality among countries regarding the services covered.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research (CAHTA)