Insulin pumps--still a research tool?

Long-term near-normal blood glucose regulation is possible with portable insulin pumps, and this treatment is acceptable to patients, but is also expensive. The pharmacokinetic difference between continuous subcutaneous insulin infusion and conventional injection therapy is discussed and can explain the difference between the obtained levels of blood glucose control. One-year near-normal blood glucose regulation cannot prevent the development of proliferative retinopathy in patients with established diabetic background retinopathy. Long-term large-scale prospective clinical trials are needed to evaluate whether strict metabolic control can prevent, delay, arrest, or even reverse microvascular complications. Furthermore, the side effects of the pump treatment need to be clarified before routine use of continuous subcutaneous insulin infusion. While awaiting these studies, the only indication for pump therapy in routine clinic is considerable glycaemic instability which is incompatible with leading a normal life.