Comparison between multiple daily insulin injection therapy (MDI) and continuous subcutaneous insulin infusion therapy (CSII), results of the five nations study

Continuous subcutaneous insulin infusion (CSII) is an alternative to multiple daily insulin injections (MDII) as intensive insulin therapy for optimising glycaemic control in type 1 diabetes. The Diabetes Control and Complications Trial (DCCT) showed the benefits of intensive insulin therapy in reducing the risk of microvascular complications. CSII was an option in the intensive control arm of the study. However, the value and place of CSII in the management of type 1 diabetes remains controversial. In this article we will present what we until recently do know about the benefits of CSII therapy and shall especially give some information about the recently published 5-Nations Study. In our view CSII usage offers significant benefits over NPH-based MDI for individuals with type 1 diabetes with improvement in all significant metabolic parameters as well as in patients' quality of life.