Insulin infusion therapy. Potential benefits and risks.

A mass of evidence favors the concept of euglycemic management of insulin-dependent diabetes, despite significant potential complications. Patients with advanced nephropathy and/or autonomic neuropathy are very poor risks, and infusion therapy does not reverse well-established complications. To well-motivated, educated patients, infusion therapy offers the conveniences of more flexible timing of meals and of having a premeal bolus infusion rather than a premeal injection. With improvement in the technology of continuous glucose monitoring and closed-loop systems, as well as basic improvements in immunologic techniques for islet transplantation, the future may offer a choice of excellent euglycemic therapies for insulin-dependent diabetes. Meanwhile, infusion therapy, which was once only a research tool, is now widely available and is appropriate for near-euglycemic management of diabetes in selected patients.