The number of pump users has increased in the past decades as a consequence of 2 main factors. The first of these is that the technology of insulin pumps has improved significantly, and pumps are now smaller, more reliable, and safer. The second factor is that several studies have demonstrated the superiority of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) therapy in type 1 diabetic patients in terms of glycemic control, the rate of hypoglycemia, glucose variability, and quality of life. [1][2][3][4][5] Nevertheless, there are no clear guidelines or recommendations available for clinicians to facilitate the transition from MDI to CSII.6-8 As a result, glycemic improvement is often delayed because insulin doses need to be adjusted after CSII initiation. CSII is usually started with a reduction of MDI doses of about 20% to 25%, a basal/bolus distribution around 50%/50%, and a flat basal rate. But it is well known that the glucose profile of type 1 diabetic patients depends on many variables, such as diabetes duration, physical activity, and the dawn phenomenon. Short information about the best way to start CSII therapy has been reported in adults. 9 Wider, more useful information about patterns of CSII insulin and patients characteristics is lacking. Although glucose profiles are intrinsically individual, identifying common patterns could be helpful for decision making, and recommendations for subgroups of type 1 diabetic patients are needed, allowing faster optimization of glycemic control.The main objective of the present study was to assess the changes in insulin requirements during the transition from MDI to CSII in adults with type 1 diabetes, studying the evolution of insulin requirements, the basal/bolus distribution, the basal rate profile over 24 hours, and the number of basal AbstractThe aim was to evaluate changes in insulin requirements from onset of continuous subcutaneous insulin infusion (CSII) until glucose optimization in type 1 diabetes and to determine patient characteristics to be considered when CSII is implemented. We retrospectively analyzed 74 type 1 diabetic patients over a follow-up of 5 months after starting CSII. Patients without a decrease in HbA1c levels at the end of follow-up were excluded. We compared total daily doses (TDD), basal/bolus distribution, basal diurnal/nocturnal proportion, number of basal segments, and HbA1c levels in relation to sex, age, body mass index (BMI), diabetes duration, and indication for CSII. At follow-up, HbA1c decreased by 0.75%, TDD decreased by 18%, basal rate was 60% of TDD, and diurnal basal rate was 60% of total basal rate. Insulin requirements were higher in males and in obese patients. Female patients and patients with longer diabetes duration showed a higher percentage of basal insulin. The number of basal segments was 4.9 ± 2.9. Basal requirements were higher in the second half of the nocturnal period. The dawn phenomenon was more relevant in men. Improvements in glycemic control were more marked in youn...

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