CONTROVERSIES in Continuous Glucose Monitoring Combining Insulin Pumps and Continuous Glucose Monitors; Where Are We to Go from Here?

Insulin pump development started in 1978, with the first commercially available glucose sensor marketed in 1999. Combining these two instruments is a logical step toward the closed loop. This article discusses three questions: Is pump development complete? How can a pump and a sensor be combined? Can the delay problem associated with the subcutaneous–subcutaneous approach for the closed loop be overcome? J Diabetes Sci Technol 2008;2(2):261-262 The widely cited meta-analysis on insulin pump therapy by its inventor, John Pickup, noted 0.51 % lower hemoglobin A1c (HbA1c), 27 % less fluctuation in blood glucose values, and 14 % lower insulin doses associated with the use of insulin pump therapy.1 However, trials analyzed in this article almost exclusively used regular human insulin and neutral protamine Hagedorn (NPH) combinations as the comparator injection regimens. When we meta-analyzed papers using rapid-actin