Is beneficial in selected patients and should be more widely available

Almost 25 years ago the BMJ published our account of a new technique for achieving long term strict blood glucose control in type 1 diabetes. Continuous subcutaneous insulin infusion,1 or insulin pump therapy, mimics physiological delivery by using a portable electromechanical pump to infuse insulin at a slow, basal rate throughout 24 hours, with patient activated boosts when food is eaten. Developed by us as a research tool to investigate the impact of greatly improved glycaemic control on diabetic complications, continuous subcutaneous insulin infusion is now used in everyday treatment by at least 130 000 people worldwide, more than 80 000 in the United States alone.

Personal testimony from patients shows that many can achieve better control and lead a more flexible life with a continuous insulin infusion than with other methods. Ironically, in the United Kingdom, the country of its invention, only a few hundred people use it, though there is growing pressure from patients to increase its availability. Doctors' commendable caution about an unfamiliar technique that places new demands on patients and carers has been massively reinforced by the NHS's reluctance to pay for continuous insulin infusion: funding in …