Introduction

The first external insulin pump device to deliver continuous subcutaneous insulin infusion (CSII or “insulin pump”) therapy was used more than 30 years ago. Subsequently, the Diabetes Control and Complications Trial (DCCT) has convincingly demonstrated that stricter glycaemic control, using insulin delivered by multiple-dose injections (MDI) or CSII, prevents and retards the progression of microvascular complications. 

Technological improvements in pump design and functionality, the wider dissemination of accumulated knowledge and the desire to achieve blood glucose values as close to the normal range as possible, have resulted in a significant increase in insulin pump use throughout the world. An increasing body of evidence supports the ability of insulin pump therapy to improve glycaemic control while reducing hypoglycaemic episodes when used in appropriately selected patients with type 1 diabetes.

The local use of insulin pumps has expanded significantly since its reintroduction into South Africa in 2001, and it can no longer be ignored as a therapeutic option for selected patients with type 1 diabetes in this country. However, if CSII is to be a viable and sustainable therapeutic alternative in appropriate patients, a balance needs to be struck between CSII use and the ability of the healthcare network to support the additional costs. The benefits of CSII should be measurable and demonstrable. Creation of an environment in which these benefits can be realised will ensure the viability and sustainability of this form of therapy in the diabetes care armamentarium.

In order to obtain the maximum and expected benefits from CSII therapy, the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA), Paediatric and Adolescent Endocrinology and Diabetes Society of South Africa (PAEDS-SA) and the Centre for Diabetes and Endocrinology (CDE) have collaborated, under the banner of the Association of Clinical Endocrinologists of South Africa (ACE-SA), to issue guidelines on CSII in South Africa.

The role of ACE-SA will be to:

• Co-ordinate the training and continuing medical education for new and established CSII facilities
• Establish and co-ordinate the CSII training for registrars and fellows seeking certification in Endocrinology and Metabolism
• Establish a voluntary database of CSII users in South Africa, and to review this data to critically analyse the impact of CSII therapy
• Publish and review CSII guidelines, and make recommendations for the recognition of CSII providers