[Treatment of diabetes with insulin pumps. Current status and insurance medicine aspects]

The continuous subcutaneous insulin infusion (CSII) by means of portable dosing devices ("insulin pumps") represents a new therapeutical principle in the treatment of type I diabetics. Developed in 1978/79, subcutaneous infusion is being used increasingly in today's routine therapy. It achieves an almost physiological distribution of insulin between a basal rate (basic insulin requirement) and additional rates (insulin requirement depending on food-intake), leading to an improvement not only in metabolism but also in the quality of patient's life (increased flexibility in everyday life). The prerequisites for successful therapy are stated and therapy-specific complications are analysed on the basis of the experience of the III. Medical Department of the City Hospital Munich-Schwabing with 104 patients over an accumulated period of 283 treatment years. An outline is given of future advancements in the field of controlled insulin dosage with the help of infusion systems. Important aspects of insurance medicine are pointed out, such as the registration of substandard risks by means of a questionnaire especially developed for that purpose and the prognostic evaluation as compared to forms of therapy applied so far. The reasons for the current classification of this new therapeutical method as prognostic/experimental are indicated and the procedure for selecting favourable risks is described.