We greatly appreciated the article by Torrance and colleagues¹ about the use of insulin pumps and we agree with their conclusion that the benefits of continuous subcutaneous insulin infusion (CSII) outweigh the disadvantages. Our three year experience with CSII at the Juvenile Diabetes Regional Centre of Tuscany has shown that not only does this form of insulin administration enhance the compliance in children and teenagers with type 1 diabetes (T1DM), but it also represents an effective way to improve the metabolic control of our patients.

We studied the entire group of 34 (16 males, 18 females) T1DM patients aged up to 18 years followed at our centre, who in the period from January 2000 to November 2002 started CSII therapy and continued it for at least one year without interruption. At the time of attaching the pump the mean age was 14.4 years (range 9–17.8) and the mean duration of diabetes was 6.2 years (range 0.6–15.8). We found that the mean HbA1c values of the group decreased from 8.35% (SD 1.08) at the beginning of the treatment with CSII, to 7.81% (SD 0.95) 12 months later (paired t test: p = 0.002). In addition, the mean daily insulin requirement of the patients dropped by 23.7%, from 58.2 IU (SD 15.3) to 44.4 IU (SD 11) (paired t test: p < 0.001); the mean body mass index did not vary significantly in the period (from 20.7 (SD 2.5) to 21.2 (SD 2.4)). During the period studied no episodes of hypoglycaemia occurred; one episode of ketoacidosis was caused by displacement of the cannula. No episode of local infection occurred. Three patients discontinued the CSII after the first year and one after the second year of treatment.

Our experience shows that use of an insulin pump improves the metabolic control of T1DM in children and adolescents, and reduces the daily insulin requirement.