Tools
Insulin Pump
Definition/Introduction
The prevalence of diabetes mellitus has increased fourfold in the last 3 to 4 decades, currently affecting more than 500 million people worldwide. Of these, 90% live with type 2 diabetes mellitus. Although type 2 diabetes mellitus is occasionally managed with solely oral medications, a significant percentage of patients require insulin for proper glycemic control. Conversely, type 1 diabetes mellitus is insulin-dependent, and epidemiological data suggest increased diagnoses among children younger than 7 years of age, posing a considerable challenge in the treatment of the condition.[1][2][3][4]
Insulin delivery has evolved remarkably over the last century. In the early 20th century, the first patient with type 1 diabetes mellitus was treated with insulin, which served as a lifesaving measure. Subsequently, advancements in insulin production led to the development of human insulin by the end of the 20th century. Currently, many insulin preparations are available, including short-acting, ultrashort-acting, long-acting, ultralong-acting, intermediate-acting, and mixed preparations.[5] The insulin analogs have been prepared through genetic engineering and are very similar to human insulin. Additionally, the development of insulin pens has tremendously improved insulin delivery in terms of ease and accuracy.
In the late 20th century, a continuous subcutaneous insulin infusion (CSII) delivery system was developed and is now commonly known as an insulin pump. The first insulin pump was about the size of an army backpack. Early closed-loop pumps were designed to deliver insulin and dextrose as needed, with a computerized algorithm calculating dosing based on real-time blood glucose measurements because the blood glucose analyzer was integrated into the insulin pump. The size and complexity of these devices limited their use, and they were used solely for research purposes.
The next generation of devices used open-loop insulin delivery, with intravenous delivery at a preset rate and boluses at 15 times the set rate. However, recurrent infections and phlebitis limited the use of these devices. In 1976, the first commercial insulin pump, called the Big Blue Brick and later termed the Autosyringe, was developed by Kamen. Complications, including hyperglycemia, diabetic ketoacidosis, and infection at the injection site, were common with early pump models, limiting the acceptance of this technology until the 1990s.
Newer and more refined technology has since revolutionized insulin pumps in terms of ease of use and quality of care, resulting in improved glycemic control. The growing popularity of these devices has made insulin pumps a mainstay of treatment for insulin-dependent diabetes mellitus.[6] Furthermore, insulin pump treatment is associated with improved glycemic control and fewer daily injections. Additionally, although the data do not document a clear difference in glycemic control among young children, results indicate increased parental satisfaction with insulin pumps.[7] Despite these technological advances, implementation gaps persist, as study findings document population disparities in access to insulin pumps even when medical insurance plans cover the cost.[8]
Insulin Pump Parts
Most insulin pumps have the following components:
- Pump
- Infusion set
- Sensor and transmitter in sensor-augmented insulin pumps
For most devices, the pump and infusion set are separate, connected by thin plastic tubing. However, some devices combine both into a single unit called the tubeless pump. The infusion set is attached to the patient with a cannula placed in the subcutaneous tissue and secured with adhesive. Infusion sets are typically placed into the upper extremity, abdomen, lower back, or upper thigh. Most clinicians recommend changing the infusion set every 3 days because scarring can affect insulin delivery and absorption. The pump also contains a refillable reservoir and a battery. The reservoir typically holds a 2- to 3-day supply of rapid-acting insulin analog, depending on the patient's total daily insulin needs, and requires replacement once all the insulin is used.
Battery requirements vary by device. Some contain a rechargeable lithium battery, whereas others require a standard alkaline battery. Pumps should always be active when a functioning battery is present. The pump will often enter standby mode to conserve battery.
From the insulin pump's home screen, clinicians and patients can review basal insulin settings and the history of delivered insulin boluses. Additionally, the home screen provides settings for priming the device when changing infusion sets and insulin reservoirs. Returning to an active home screen requires a specific sequence of button presses that varies by device.
Insulin Types
The insulin pump typically infuses rapid-acting insulin such as insulin lispro, insulin aspart, or insulin glulisine.[9] Newer formulations of insulin lispro and insulin aspart with faster onset of action, named ultrarapid insulin lispro-aabc and faster-acting insulin aspart, respectively, have been used safely for insulin pump therapy.[10][11][12] The faster onset is achieved by increasing vascular permeability and local vasodilation with excipients such as niacinamide, and using insulin aspart and treprostinil sodium for ultrarapid insulin lispro. The benefit of using ultrarapid insulin in CSII appears to be improved postprandial glucose control. However, the trade-off is an increased incidence of infusion site reactions.[11]
Insulin pumps have a limited reservoir size, holding 1.6 to 3.0 mL, equivalent to 160 to 300 units of U100 insulin. For patients with a high total daily dose of insulin (TDD), insulin pump therapy previously had not been recommended due to frequent reservoir refills and changes. The development of concentrated rapid-acting insulin at 200 units/mL (U200) and reports of its safety across multiple insulin pump devices may increase access to insulin pump therapy for patients with high TDD.[13]
Insulin Delivery
Basal
Insulin is continuously delivered at a preset or auto-adjusted rate to provide a 24-hour basal supply.
Mealtime bolus
Insulin is also delivered at mealtimes. The bolus is calculated based on the number of carbohydrates the patient consumes. The insulin-to-carbohydrate ratio (ICR) must be entered into the pump by the patient or their clinician beforehand and is calculated as ICR = 450/TDD. The ICR reflects the number of grams of carbohydrates that 1 unit of insulin covers. With insulin pumps, there are options for different bolus profiles, including dual-wave, short-extended, and long-extended boluses, which are discussed below.[14]
The patient also receives a correction bolus along with the mealtime bolus of insulin, and the correction is calculated using the insulin sensitivity factor (ISF). The ISF reflects the amount by which blood glucose decreases per 1 unit of insulin, calculated as 1700/TDD for rapid-acting insulin. Currently, 2 different modes are available for insulin pump use:
- Auto mode (hybrid closed-loop): In this mode, the pump is wirelessly linked with and receives glucose values from a continuous glucose monitoring device.[15] Preset algorithms adjust the basal insulin delivery rate based on blood glucose levels. Examples include quantification of basal insulin and control insulin as auto mode options. Temporary basal rates are also available with higher or lower insulin requirements, with the rate adjusted based on the ISF.
- Manual mode: In this mode, the clinician can set a predetermined hourly basal rate based on the patient's total daily insulin dose. The rates can be adjusted and must be entered manually.
The hybrid closed-loop system is the first generation of automated insulin delivery, dynamically modulating basal insulin delivery based on continuous glucose monitoring values, but it still requires patients to administer boluses.[16] A fully closed-loop insulin pump system, in which the patient inputs their weight and reports the carbohydrate content of the meal as usual, more, or less, has shown promise in improving glycemic control compared with the standard of care.[17][18] Some new modalities are currently under development, such as fully automated multihormonal closed-loop systems.[19]
Special Insulin Pump Features
Automated adjustment of bolus calculators is available to improve glycemic control and avoid postprandial blood glucose spikes.[20]
Dual-wave bolus
A standard premeal insulin bolus followed by an extended bolus delivered evenly over many hours as programmed by the patient. Results from a study comparing standard bolus delivery with the dual-wave bolus showed improved glycemic control in patients receiving the dual-wave bolus, because prolonged postprandial hyperglycemic excursions were prevented.[21]
Duration of insulin action
Duration of insulin action is the time required for rapid-acting insulin to control blood glucose, reflecting a 20% to 25% decline in bolus activity each hour. Consequently, a certain percentage of insulin remains available after 3 to 4 hours. In general, the greater the bolus amount of insulin, the higher the amount of insulin available at the end of that time.[22] The term insulin on board refers to the amount of insulin available after a bolus is delivered for the next 3 to 5 hours, as determined by the insulin pump's preset insulin action time.
Hypoglycemia suspension
This function, referred to as threshold suspend or low-glucose suspend, is a feature of the pumps in auto mode with the sensor-augmented version.[23] Results show a 40% to 50% decrease in the rate of hypoglycemia without any significant increase in hemoglobin A1c. Another technology, known as predictive low-glucose suspend, will suspend insulin delivery almost 30 minutes before hypoglycemia is expected.
Issues of Concern
Register For Free And Read The Full Article
Search engine and full access to all medical articles- 10 free questions in your specialty
- Free CME/CE Activities
- Free daily question in your email
- Save favorite articles to your dashboard
- Emails offering discounts
Learn more about a Subscription to StatPearls Point-of-Care
Issues of Concern
Infusion site infection, erythema, induration, tenderness to palpation, and signs of fluid leakage from the infusion site are among the most common problems that can arise, and all are indications for removal and selection of a new site at a different location.[24] Long-term use of insulin pumps has been shown to cause chronic skin inflammation and fibrosis. Allergic reactions to the materials used in the pump device, including infusion sets, can occur and ultimately contribute to pump failure.[25]
Hyperglycemia
Insulin analogs are rapid-acting, with an onset of action within 15 minutes, peaking in approximately 60 minutes, and lasting fewer than 5 hours after injection. In patients receiving CSII, hyperglycemia secondary to insulin delivery disruption must be considered in the differential diagnosis. The clinician should always examine the infusion site during the physical examination. The easiest way to evaluate the site is to deliver an insulin bolus via the pump and recheck blood glucose levels. If blood glucose levels remain elevated despite the insulin bolus, the tubing or infusion set is likely compromised and requires replacement.[26] If the patient is unable to replace the unit, restarting multiple daily injections of long-acting and short-acting insulin should be implemented. The daily requirement for long-acting insulin can be calculated from the patient's total daily basal rate.
Diabetic Ketoacidosis
Because insulin analogs remain active for a relatively short duration, the risk for diabetic ketoacidosis is a concern, because patients may not receive sufficient long-acting insulin. Results from studies comparing the incidence of diabetic ketoacidosis in patients receiving CSII versus multiple daily injections demonstrated lower rates of diabetic ketoacidosis in patients receiving CSII.[27]
In rare cases, insulin pump site changes are associated with hypoglycemia after an accidental insulin bolus is delivered.[28] In these reported cases, the events were preceded by a pump site change and an alarm, indicating that a high-dose insulin bolus was delivered without the patient's appropriate bolus instructions, resulting in hypoglycemia. Clinicians must be aware of this possible complication when using insulin pumps.
Clinical Significance
Results from an initial randomized study by DeVries comparing CSII with multiple daily injections with neutral protamine Hagedorn (NPH) and regular insulin demonstrated a reduction in hemoglobin A1c of 0.84% at 16 weeks.[29] Results from a larger clinical trial, the 5-Nations trial, performed in 11 European centers reported a decrease in hemoglobin A1c of 0.22% and a lower incidence of hypoglycemic events, along with higher patient satisfaction, when comparing CSII with multiple daily NPH injections.[30][31]
Hypoglycemia
Continuous subcutaneous insulin infusion is associated with lower hemoglobin A1c levels, raising concerns for an increased risk of hypoglycemia. Results from studies showed that event rates of severe hypoglycemia and hypoglycemic coma were significantly lower with CSII versus multiple daily injections.[27] Notably, results from several studies have reported a decrease in blood glucose variability in patients using insulin pumps.[32] Findings from preliminary studies suggest that blood glucose variability is the underlying pathophysiologic mechanism leading to diabetic complications, including nephropathy, retinopathy, coronary artery disease, and cognitive decline, although more research is needed to establish causation.[33]
Clinical Indications for Insulin Pump Therapy
The following patients could benefit from insulin pump therapy:
- All patients with type 1 diabetes mellitus [34]
- Patients with type 2 diabetes mellitus who do not meet glycemic targets despite multiple daily insulin injections and extensive lifestyle changes [25][35]
- Individuals with gastroparesis using the insulin pump's extended bolus delivery feature [36]
- Pregnancy [37]
- Variable schedule or shift workers [36]
- Patients requiring small doses of insulin, such as children with diabetes mellitus [38]
Ideal candidates for insulin pump therapy
Patients pursuing insulin pump therapy should have the following:
- Willingness to wear the insulin pump and the sensor
- Motivation and interest in pump education
- Acceptable visual acuity
- Ability to operate the pump and make necessary adjustments
- Knowledge of carb counting
- Ability to calculate the insulin bolus from the device.
Insulin pump technology will continue to develop rapidly, improving the quality of life for patients with diabetes mellitus. Staying abreast of every advancement will be challenging for clinicians. However, a basic understanding of insulin pump delivery can help avoid common complications and improve outcomes. Results from some studies suggest potential cardiovascular benefits, both for acute and chronic events, from the use of insulin pumps in patients with type 1 diabetes mellitus, a finding that warrants further study across all populations of patients with diabetes mellitus of any type.[39]
Nursing, Allied Health, and Interprofessional Team Interventions
The interprofessional team must maintain strong communication during transitions of care so that all clinicians involved in managing the patient's health are aware that the patient is receiving insulin pump therapy. The patient or a certified pump specialist should adjust the pump settings, including insulin boluses, temporary basal settings, and other basal rate changes. Persistent hyperglycemia, infusion-site problems, or device removal should be reported to the clinician promptly.
Most hospitals have a policy allowing patients to continue using their insulin pumps while in the hospital.[40] However, patients should be able to consent to and independently manage their insulin pump, because hospital personnel are usually not trained to manage insulin pumps. Ultimately, pump management is the patient's responsibility, including all pump changes, to ensure optimal blood glucose control. In all settings, clinical staff have can suspend the insulin pump and start the patient on a conventional insulin regimen for the management of their diabetes mellitus when considered to be in the best interest of the patient, such as in situations of anesthesia, any critical change in the patient's mental or general health status, or when the patient is not fully awake or capable of managing the insulin pump independently.
Nursing, Allied Health, and Interprofessional Team Monitoring
Nursing staff should maintain a log of blood glucose levels and basal rates on the insulin pump, which usually requires the patient to report all glucose levels, especially when using continuous glucose monitoring.[41] Individual requirements may vary by hospital. However, most institutions require documentation demonstrating that the patient consents to and can independently manage the insulin pump in accordance with hospital policy.[42]
References
Bratke H, Margeirsdottir HD, Assmus J, Njølstad PR, Skrivarhaug T. Does Current Diabetes Technology Improve Metabolic Control? A Cross-Sectional Study on the Use of Insulin Pumps and Continuous Glucose Monitoring Devices in a Nationwide Pediatric Population. Diabetes therapy : research, treatment and education of diabetes and related disorders. 2021 Sep:12(9):2571-2583. doi: 10.1007/s13300-021-01127-6. Epub 2021 Aug 13 [PubMed PMID: 34389930]
Level 2 (mid-level) evidenceMarks BE, Wolfsdorf JI, Waldman G, Stafford DE, Garvey KC. Pediatric Endocrinology Trainees' Education and Knowledge About Insulin Pumps and Continuous Glucose Monitors. Diabetes technology & therapeutics. 2019 Mar:21(3):105-109. doi: 10.1089/dia.2018.0331. Epub 2019 Jan 25 [PubMed PMID: 30681363]
Kandemir N, Vuralli D, Ozon A, Gonc N, Ardicli D, Jalilova L, Gulcek ON, Alikasifoglu A. Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience. Journal of diabetes. 2024 May:16(5):e13562. doi: 10.1111/1753-0407.13562. Epub [PubMed PMID: 38664892]
Bell KJ, Lain SJ. The Changing Epidemiology of Type 1 Diabetes: A Global Perspective. Diabetes, obesity & metabolism. 2025 Aug:27 Suppl 6(Suppl 6):3-14. doi: 10.1111/dom.16501. Epub 2025 Jun 19 [PubMed PMID: 40536127]
Level 3 (low-level) evidenceSebastian SA, Co EL, Mehendale M, Hameed M. Insulin analogs in the treatment of type II diabetes and future perspectives. Disease-a-month : DM. 2023 Mar:69(3):101417. doi: 10.1016/j.disamonth.2022.101417. Epub 2022 Apr 27 [PubMed PMID: 35487767]
Level 3 (low-level) evidenceRimon MTI, Hasan MW, Hassan MF, Cesmeci S. Advancements in Insulin Pumps: A Comprehensive Exploration of Insulin Pump Systems, Technologies, and Future Directions. Pharmaceutics. 2024 Jul 15:16(7):. doi: 10.3390/pharmaceutics16070944. Epub 2024 Jul 15 [PubMed PMID: 39065641]
Level 3 (low-level) evidenceCummins E, Royle P, Snaith A, Greene A, Robertson L, McIntyre L, Waugh N. Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation. Health technology assessment (Winchester, England). 2010 Feb:14(11):iii-iv, xi-xvi, 1-181. doi: 10.3310/hta14110. Epub [PubMed PMID: 20223123]
Level 1 (high-level) evidenceTremblay ES. Persistent Socioeconomic Disparities in Insulin Pump Uptake Despite Universal Health Coverage-Nonmonetary Drivers in Insulin Pump Use. JAMA network open. 2022 May 2:5(5):e2210471. doi: 10.1001/jamanetworkopen.2022.10471. Epub 2022 May 2 [PubMed PMID: 35507348]
Lane WS, Weinrib SL, Lawrence MJ, Lane BC, Jarrett RT. Basal Insulin Degludec and Glycemic Control Compared to Aspart Via Insulin Pump in Type 1 Diabetes (BIGLEAP): A Single-Center, Open-Label, Randomized, Crossover Trial. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2022 Feb:28(2):165-172. doi: 10.1016/j.eprac.2021.11.001. Epub 2021 Nov 9 [PubMed PMID: 34763071]
Level 1 (high-level) evidenceLevy CJ, Bailey R, Laffel LM, Forlenza G, DiMeglio LA, Hughes MS, Brown SA, Aleppo G, Bhargava A, Shah VN, Clements MA, Kipnes M, Bruggeman B, Daniels M, Rodriguez H, Calhoun P, Lum JW, Sasson-Katchalski R, Pinsker JE, Pollom R, Beck RW, TL1 Study Group. Multicenter Evaluation of Ultra-Rapid Lispro Insulin with Control-IQ Technology in Adults, Adolescents, and Children with Type 1 Diabetes. Diabetes technology & therapeutics. 2024 Sep:26(9):652-660. doi: 10.1089/dia.2024.0048. Epub 2024 May 22 [PubMed PMID: 38696672]
Bode BW, Garg SK, Norwood P, Morales C, Hardy T, Liu R, Ignaut D. Compatibility and Safety of Ultra Rapid Lispro with Continuous Subcutaneous Insulin Infusion in Patients with Type 1 Diabetes: PRONTO-Pump Study. Diabetes technology & therapeutics. 2021 Jan:23(1):41-50. doi: 10.1089/dia.2020.0224. Epub 2020 Jul 30 [PubMed PMID: 32640842]
Aleppo G, Bode B, Carlson AL. Can Faster Aspart Be Used to Optimize Glycemic Control With Insulin Pump Therapy? From Expectations to Lessons Learned After a Year of Use in the United States. Clinical diabetes : a publication of the American Diabetes Association. 2022 Fall:40(4):413-424. doi: 10.2337/cd21-0056. Epub [PubMed PMID: 36381308]
Akcan T, Needleman L, Basina M. Safe and Effective Use of U-200 Insulin With Automated Insulin Delivery Systems. Clinical diabetes : a publication of the American Diabetes Association. 2025 Summer:43(3):449-452. doi: 10.2337/cd24-0110. Epub 2025 Mar 12 [PubMed PMID: 40741456]
Kamecke U, Waldenmaier D, Haug C, Ziegler R, Freckmann G. Establishing Methods to Determine Clinically Relevant Bolus and Basal Rate Delivery Accuracy of Insulin Pumps. Journal of diabetes science and technology. 2019 Jan:13(1):60-67. doi: 10.1177/1932296818788349. Epub 2018 Jul 13 [PubMed PMID: 30003823]
Natale P, Chen S, Chow CK, Cheung NW, Martinez-Martin D, Caillaud C, Scholes-Robertson N, Kelly A, Craig JC, Strippoli G, Jaure A. Patient experiences of continuous glucose monitoring and sensor-augmented insulin pump therapy for diabetes: A systematic review of qualitative studies. Journal of diabetes. 2023 Dec:15(12):1048-1069. doi: 10.1111/1753-0407.13454. Epub 2023 Aug 8 [PubMed PMID: 37551735]
Level 1 (high-level) evidenceBeck RW, Kanapka LG, Breton MD, Brown SA, Wadwa RP, Buckingham BA, Kollman C, Kovatchev B. A Meta-Analysis of Randomized Trial Outcomes for the t:slim X2 Insulin Pump with Control-IQ Technology in Youth and Adults from Age 2 to 72. Diabetes technology & therapeutics. 2023 May:25(5):329-342. doi: 10.1089/dia.2022.0558. Epub 2023 Apr 12 [PubMed PMID: 37067353]
Level 1 (high-level) evidenceBionic Pancreas Research Group, Russell SJ, Beck RW, Damiano ER, El-Khatib FH, Ruedy KJ, Balliro CA, Li Z, Calhoun P, Wadwa RP, Buckingham B, Zhou K, Daniels M, Raskin P, White PC, Lynch J, Pettus J, Hirsch IB, Goland R, Buse JB, Kruger D, Mauras N, Muir A, McGill JB, Cogen F, Weissberg-Benchell J, Sherwood JS, Castellanos LE, Hillard MA, Tuffaha M, Putman MS, Sands MY, Forlenza G, Slover R, Messer LH, Cobry E, Shah VN, Polsky S, Lal R, Ekhlaspour L, Hughes MS, Basina M, Hatipoglu B, Olansky L, Bhangoo A, Forghani N, Kashmiri H, Sutton F, Choudhary A, Penn J, Jafri R, Rayas M, Escaname E, Kerr C, Favela-Prezas R, Boeder S, Trikudanathan S, Williams KM, Leibel N, Kirkman MS, Bergamo K, Klein KR, Dostou JM, Machineni S, Young LA, Diner JC, Bhan A, Jones JK, Benson M, Bird K, Englert K, Permuy J, Cossen K, Felner E, Salam M, Silverstein JM, Adamson S, Cedeno A, Meighan S, Dauber A. Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. The New England journal of medicine. 2022 Sep 29:387(13):1161-1172. doi: 10.1056/NEJMoa2205225. Epub [PubMed PMID: 36170500]
Level 1 (high-level) evidenceBoughton CK, Hartnell S, Lakshman R, Nwokolo M, Wilinska ME, Ware J, Allen JM, Evans ML, Hovorka R. Fully Closed-Loop Glucose Control Compared With Insulin Pump Therapy With Continuous Glucose Monitoring in Adults With Type 1 Diabetes and Suboptimal Glycemic Control: A Single-Center, Randomized, Crossover Study. Diabetes care. 2023 Nov 1:46(11):1916-1922. doi: 10.2337/dc23-0728. Epub [PubMed PMID: 37616583]
Level 1 (high-level) evidenceWeaver KW, Hirsch IB. The Hybrid Closed-Loop System: Evolution and Practical Applications. Diabetes technology & therapeutics. 2018 Jun:20(S2):S216-S223. doi: 10.1089/dia.2018.0091. Epub 2018 Jun 6 [PubMed PMID: 29873517]
Herrero P, Pesl P, Bondia J, Reddy M, Oliver N, Georgiou P, Toumazou C. Method for automatic adjustment of an insulin bolus calculator: in silico robustness evaluation under intra-day variability. Computer methods and programs in biomedicine. 2015 Apr:119(1):1-8. doi: 10.1016/j.cmpb.2015.02.003. Epub 2015 Feb 16 [PubMed PMID: 25733405]
Metwally M, Cheung TO, Smith R, Bell KJ. Insulin pump dosing strategies for meals varying in fat, protein or glycaemic index or grazing-style meals in type 1 diabetes: A systematic review. Diabetes research and clinical practice. 2021 Feb:172():108516. doi: 10.1016/j.diabres.2020.108516. Epub 2020 Oct 20 [PubMed PMID: 33096184]
Level 1 (high-level) evidenceRosales N, De Battista H, Vehí J, Garelli F. Open-loop glucose control: Automatic IOB-based super-bolus feature for commercial insulin pumps. Computer methods and programs in biomedicine. 2018 Jun:159():145-158. doi: 10.1016/j.cmpb.2018.03.007. Epub 2018 Mar 9 [PubMed PMID: 29650309]
Grassi B, Onetto MT, Zapata Y, Jofré P, Echeverría G. Lower versus standard sucrose dose for treating hypoglycemia in patients with type 1 diabetes mellitus in therapy with predictive low glucose suspend (PLGS) augmented insulin pumps: A randomized crossover trial in Santiago, Chile. Diabetes & metabolic syndrome. 2021 May-Jun:15(3):695-701. doi: 10.1016/j.dsx.2021.03.017. Epub 2021 Mar 23 [PubMed PMID: 33813244]
Level 1 (high-level) evidenceBerg AK, Nørgaard K, Thyssen JP, Zachariae C, Hommel E, Rytter K, Svensson J. Skin Problems Associated with Insulin Pumps and Sensors in Adults with Type 1 Diabetes: A Cross-Sectional Study. Diabetes technology & therapeutics. 2018 Jul:20(7):475-482. doi: 10.1089/dia.2018.0088. Epub 2018 Jun 12 [PubMed PMID: 29893593]
Level 2 (mid-level) evidenceEkanayake P, Edelman S. Identifying patients with type 2 diabetes who might benefit from insulin pump therapy: Literature review, clinical opportunities, potential benefits and challenges. Diabetes, obesity & metabolism. 2023 Jul:25 Suppl 2():3-20. doi: 10.1111/dom.15059. Epub 2023 Apr 13 [PubMed PMID: 36949618]
Dogan ADA, Jørgensen UL, Gjessing HJ. Diabetic Ketoacidosis Among Patients Treated With Continuous Subcutaneous Insulin Infusion. Journal of diabetes science and technology. 2017 May:11(3):631-632. doi: 10.1177/1932296816668375. Epub 2016 Sep 5 [PubMed PMID: 27595713]
Karges B, Schwandt A, Heidtmann B, Kordonouri O, Binder E, Schierloh U, Boettcher C, Kapellen T, Rosenbauer J, Holl RW. Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes. JAMA. 2017 Oct 10:318(14):1358-1366. doi: 10.1001/jama.2017.13994. Epub [PubMed PMID: 29049584]
Faulds ER, Wyne KL, Buschur EO, McDaniel J, Dungan K. Insulin Pump Malfunction During Hospitalization: Two Case Reports. Diabetes technology & therapeutics. 2016 Jun:18(6):399-403. doi: 10.1089/dia.2015.0434. Epub 2016 Mar 30 [PubMed PMID: 27027151]
Level 3 (low-level) evidenceDeVries JH, Snoek FJ, Kostense PJ, Masurel N, Heine RJ, Dutch Insulin Pump Study Group. 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 Nov:25(11):2074-80 [PubMed PMID: 12401759]
Level 1 (high-level) evidenceHoogma RP, Hammond PJ, Gomis R, Kerr D, Bruttomesso D, Bouter KP, Wiefels KJ, de la Calle H, Schweitzer DH, Pfohl M, Torlone E, Krinelke LG, Bolli GB, 5-Nations Study Group. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabetic medicine : a journal of the British Diabetic Association. 2006 Feb:23(2):141-7 [PubMed PMID: 16433711]
Level 1 (high-level) evidenceMcAuley SA, Vogrin S, Lee MH, Paldus B, Trawley S, de Bock MI, Abraham MB, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Hendrieckx C, Holmes-Walker DJ, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Speight J, Stranks SN, Sundararajan V, Ward GM, Jones TW, O'Neal DN, Australian JDRF Closed-Loop Research Group. Less Nocturnal Hypoglycemia but Equivalent Time in Range Among Adults with Type 1 Diabetes Using Insulin Pumps Versus Multiple Daily Injections. Diabetes technology & therapeutics. 2021 Jun:23(6):460-466. doi: 10.1089/dia.2020.0589. Epub 2021 Jan 27 [PubMed PMID: 33351699]
Petrelli F, Cangelosi G, Scuri S, Pantanetti P, Lavorgna F, Faldetta F, De Carolis C, Rocchi R, Debernardi G, Florescu A, Nittari G, Sagaro GG, Garda G, Nguyen CTT, Grappasonni I. Diabetes and technology: A pilot study on the management of patients with insulin pumps during the COVID-19 pandemic. Diabetes research and clinical practice. 2020 Nov:169():108481. doi: 10.1016/j.diabres.2020.108481. Epub 2020 Sep 28 [PubMed PMID: 33002544]
Level 3 (low-level) evidenceZhang ZY, Miao LF, Qian LL, Wang N, Qi MM, Zhang YM, Dang SP, Wu Y, Wang RX. Molecular Mechanisms of Glucose Fluctuations on Diabetic Complications. Frontiers in endocrinology. 2019:10():640. doi: 10.3389/fendo.2019.00640. Epub 2019 Sep 18 [PubMed PMID: 31620092]
Level 2 (mid-level) evidenceZhang L, Leng X, Tian F, Xiao D, Xuan J, Yang H, Liu J, Chen Z. Cost-effectiveness analysis of continuous subcutaneous insulin infusion versus multiple daily insulin for treatment of children with type 1 diabetes. Postgraduate medicine. 2022 Aug:134(6):627-634. doi: 10.1080/00325481.2022.2088938. Epub 2022 Jun 29 [PubMed PMID: 35695267]
Li Q, Wang L, Xiao L, Wang Z, Wang F, Yu X, Yan S, Wang Y. Effect of intensive insulin therapy on first-phase insulin secretion in newly diagnosed type 2 diabetic patients with a family history of the disease. Experimental and therapeutic medicine. 2015 Feb:9(2):612-618 [PubMed PMID: 25574243]
Morros-González E, Gómez AM, Henao Carrillo DC, Ursida V, Serrano S, Rondón Sepúlveda MA, Muñoz Velandia OM. Efficacy and safety of sensor augmented insulin pump therapy with low-glucose suspend feature in older adults: A retrospective study in Bogota, Colombia. Diabetes & metabolic syndrome. 2021 May-Jun:15(3):649-653. doi: 10.1016/j.dsx.2021.02.029. Epub 2021 Feb 24 [PubMed PMID: 33813236]
Level 2 (mid-level) evidenceO'Malley G, Ozaslan B, Levy CJ, Castorino K, Desjardins D, Levister C, McCrady-Spitzer S, Church MM, Kaur RJ, Reid C, Kremers WK, Doyle FJ, Trinidad MC, Rosenn B, Pinsker JE, Kudva YC, Dassau E. Longitudinal Observation of Insulin Use and Glucose Sensor Metrics in Pregnant Women with Type 1 Diabetes Using Continuous Glucose Monitors and Insulin Pumps: The LOIS-P Study. Diabetes technology & therapeutics. 2021 Dec:23(12):807-817. doi: 10.1089/dia.2021.0112. Epub 2021 Aug 17 [PubMed PMID: 34270347]
Alemzadeh R, Palma-Sisto P, Holzum M, Parton E, Kicher J. Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus. Diabetes technology & therapeutics. 2007 Aug:9(4):339-47 [PubMed PMID: 17705689]
Pauley ME, Tommerdahl KL, Snell-Bergeon JK, Forlenza GP. Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits. Current cardiology reports. 2022 Dec:24(12):2043-2056. doi: 10.1007/s11886-022-01799-x. Epub 2022 Oct 24 [PubMed PMID: 36279036]
Umpierrez GE, Klonoff DC. Diabetes Technology Update: Use of Insulin Pumps and Continuous Glucose Monitoring in the Hospital. Diabetes care. 2018 Aug:41(8):1579-1589. doi: 10.2337/dci18-0002. Epub 2018 Jun 23 [PubMed PMID: 29936424]
Vettoretti M, Facchinetti A. Combining continuous glucose monitoring and insulin pumps to automatically tune the basal insulin infusion in diabetes therapy: a review. Biomedical engineering online. 2019 Mar 29:18(1):37. doi: 10.1186/s12938-019-0658-x. Epub 2019 Mar 29 [PubMed PMID: 30922295]
Yeh T, Yeung M, Mendelsohn Curanaj FA. Managing Patients with Insulin Pumps and Continuous Glucose Monitors in the Hospital: to Wear or Not to Wear. Current diabetes reports. 2021 Jan 15:21(2):7. doi: 10.1007/s11892-021-01375-7. Epub 2021 Jan 15 [PubMed PMID: 33449214]