Continuous Subcutaneous Insulin Infusion (CSII) in Diabetic Pregnancy: A Review

In 2008, ADA provided new standards of care and recommendations including therapeutic actions favourably affecting health outcomes of patients with diabetes. In this context, Continuous Subcutaneous Insulin Infusion (CSII) becomes a great flexible therapeutic alternative, because of glucose sensors' availability, theoretical support and improved therapeutic decisions. However, there are no conclusive studies on the benefits of CSII in pregnancy. In particular, ‘80’ randomized and controlled trials describe the pregnancy outcomes of few type 1 and type 2 diabetic patients. A recent Cochrane review, including 61 pregnancies concluded that there is no sufficient evidence to support any sort of insulin administration in diabetic pregnancy. Similar conclusions were reported by another review and a meta-analysis of 6 randomized and controlled trials on 213 subjects. No better results were obtained by recent retrospective studies. Doubts exist about CSII timing (before/and or after conception). Poor results are due to the inadequate patients selection, education, and abilities. Multi -centre studies are needed to verify the real utility of insulin pump during pregnancy, considering risks, costs and benefits including quality of life, in order to outline recommendations for an appropriate use. This review article also discussed some recent patents related to the field.