The Business of Insulin Pumps in Diabetes Care: Clinical and Economic Considerations

Insulin pumps provide one of three commercially available technologies for insulin delivery. In comparison to syringe-injected insulin and pen-injected insulin, continuous subcutaneous insulin infusion (CSII) via an insulin pump is perceived and marketed to be the most sophisticated and flexible method of providing insulin therapy.1,2 Professional and consumer information programs provided by insulin pump manufacturers in the United States have emphasized that this flexibility and sophistication may result in enhanced glycemic control and improved quality of life for insulin-requiring diabetic patients. People who use insulin pumps are said to enjoy increased discretion in daily living patterns compared to those using other forms of insulin administration. There is also a perception among at least some health care professionals and consumers that CSII can help achieve enhanced glycemic control with a reduced risk of hypoglycemic events. These impressions have led to substantial growth in the market for insulin pumps during the two decades since their introduction. Because of its perceived sophistication and flexibility, CSII was included in the intensive therapy protocols of the Diabetes Control and Complications Trial (DCCT).3 However, CSII should not be considered without appropriate caveats. The annual costs of this therapy, including periodic replacement of pumps with “upgrades,” may be substantially higher than those of other forms of insulin administration. In at least some patient subgroups, pump use may have no positive effect on clinical status or may even worsen it.4 Because other forms of insulin administration, particularly pen injection devices, are now being advocated more widely, the evidence of clinical benefit and relative costs of these …