Psychological Considerations for Patient Selection and Adjustment to Insulin Pump Therapy

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Abstract
An increasing number of patients and physicians are choosing continuous subcutaneous insulin infusion (CSII) therapy to maximize glycemic control. Studies of pump users, however, show a dropout rate of 29 % to 90%. Medical reasons alone do not account for this significant discontinuation rate. Like dialysis and pacemaker patients, insulin pump users must cope with feelings about mechanical depen dency, body image, privacy, trust, and loss of control. A detailed psychological assessment is essential to evaluate the emotional and psychosocial issues that may affect adherence. An overview of the psychosocial considerations for patient selection and subse quent adjustment to CSII is presented. They form the basis for the counseling and education interventions needed by patients considering and implementing pump therapy.