[Insulin therapy with microinfusion devices. Review of the literature]

The aim of the present work is to review the most recent data in the literature about the problems, true advantages and limits of continuous infusion of insulin in the therapy of insulin-dependent diabetes mellitus. After a report on the kinds of microinfusors available today and the possible ways of continuously administering insulin, some aspects of CSII (continuous subcutaneous insulin infusion) are reviewed: indications, side effects, patterns of insulin flow programming and psychological aspects. The need for preliminary selection of the patients who are to undergo instructive courses is emphasized. Then the data from the literature about the effects of continuous infusional therapy in relation to metabolic alterations and the later complications of diabetes are analysed. These important aspects are compared with the results of conventional insulin therapy. Finally, the effects of continuous infusional therapy during pregnancy, on brittle diabetes, on insulin sensitivity and on the "down phenomenon" are analysed. It is concluded that, even if you cannot formulate a definitive opinion about this topic, microinfusors can be a functional means of achieving excellent metabolic control. Nevertheless, their greater efficiency in comparison with the so-called optimized insulin therapy has not been unequivocably demonstrated, and the real need for them at the present time appears to be exceptional.