In the past few decades, there has been rapid progress in the number of patients using subcutaneous insulin infusion (CSII) pump therapy due to its enhanced ability in glycaemic control and lower risk of hypoglycemia for type-1 diabetics. Current CSII therapy requires patients to wear an infusion set linked to a pump that mimics the way the human pancreas work by delivering small doses of short-acting insulin and variable amounts of insulin while a meal is eaten. An infusion set consists of a thin tube/cannula inserted into the subcutaneous tissue at an angle (made from plastic, steel, or Teflon) and a plastic connector mounted on an adhesive patch stuck at the insertion site. A patient reliant on CSII pump therapy can just remove the connector to disconnect from the insulin pump temporarily without detaching the entire infusion set. Some infusion sets can be inserted manually while others can be inserted through an insertion device. For the success of CSII therapy to manage diabetes, the person needs to choose the right infusion sets according to their unique needs and preferences. 

Medtronic offers a wide range of infusion sets with different cannula types, material, length, colour, insertion device, length of tubing, and angle of insertion for ultimate safety and comfort. Medtronic is the only company to provide four varied types of infusion sets with over 20 different configurations to match the specific needs of the individual. Medtronic’s infusion set is designed for extremely active individuals, pregnant women, children, or anyone who is whether new to the technology or experienced. The Medtronic device gives flexibility to the patient to wear the infusion set at alternate sites to minimize scarring, local tissue reactions, and infections at the insertion sites. Besides, the highly advanced infusion sets ensure more secure insulin delivery with audible click, silicone membrane for the watertight reservoir, four vents in the connector for minimizing blockage.

MINIMED® QUICK-SET™ INFUSION SET

The MINIMED® QUICK-SET™ infusion set comes with a 90-degree soft cannula that allows optimal insulin absorption providing consistent insertion depth. The infusion set combines ease of use with maximum comfort enabling virtually painless insertion in even hard-to-reach areas. The infusion set is highly suitable for children and adults with average to large build and it conveniently disconnects at the infusion site. The infusion set is one of the most popular sets, which comes in various tubing and cannula lengths. For inserting cannula under the skin, Quick-serter^TM device can be used. The device needs to be changed every 48-72 hours for enhanced insulin absorption, reduce insulin degradation and avoid obstruction. The infusion set can be used if you have a moderate lifestyle, often use alternate infusion sites, and have poor dexterity. People with low body mass index should use a 6 cm cannula and 18” or 23” tubing is ideal for those who prefer to wear an insulin pump close to the infusion site otherwise 32” or 43” works well. 

MINIMED® MIO™INFUSION SET

Minimed Mio is designed for All-in-one convenience integrating the set and insertion device in a single unit. The easy to insert and carry device comes in a variety of colors and can be inserted with only four steps. The infusion set has a 90-degree soft cannula and integrated inserter for virtually painless insertion. The infusion set comes in a variety of colors such as transparent blue or pink. The MiniMed Mio advanced infusion set has a hidden needle throughout insertion and allows the user to insert with one hand (left or right). The set is ideal for people who have a moderately active lifestyle, often change insertion sites, are often on the go, and would like an option for colors. People with low or average BMI should wear a cannula of 6 mm length. 32” tubing would be the best fit for those who prefer wearing an insulin pump close to the infusion site. 9 mm cannula length and 32” tubing is the best fit for people with an average of high BMI. 

MINIMED® SILHOUETTE™INFUSION SET

MiniMed Silhouette comes with a variable insertion angle from 20^o to 45^o degrees providing the patient with the flexibility to adjust the depth of insertion. The thin profile of Silhouette makes it ideal for children and adults with lean physiques, pregnant women, or active people. The MiniMed® silhouette features a soft Teflon cannula and Sil-serter® for virtually painless insertion within a click of a button. The Silhouette and reservoir need to be changed every 72 hours. People with low or average BMI should use a 13 mm cannula and those with high should use a 17 mm cannula. For those wearing insulin pumps close to the infusion site, 18” or 23” tubing is right for you, otherwise 32” and 43” tubing works well. 

MINIMED® SURE-T™INFUSION SET

MiniMed Sure-T is designed for enhanced security and continuous insulin delivery. The infusion set features an ultra-thin kink-free needle, thinnest among the MiniMed portfolio for convenience. MiniMed Sure T has an extra disconnecting site, other than the infusion site for improved flexibility and prevents clogging and dislodging. The infusion set is ideal for infants, pregnant women, people with a history of bent cannulas with other insertion sites, and those allergic to Teflon or reaction to the infusion set with plastic cannulas. The infusion set must be changed every 24 to 48 hours for proper prevention and care of the infusion site. People with low or average BMI should use 6 mm needle length and use 18” or 23” tubing if they wear a device close to the infusion site. People with average or high BMI use 8 mm or 10 mm needle length and use 23” or 32” tubing if they wear a device close to the infusion site.

Recently, Medtronic has launched the world’s first and only infusion set that allows patients to wear it for seven days instead of recommended three days. The advanced infusion set technology allows people on insulin pump therapy to change their pump and set at the same time enabling fewer interruptions and reduced mental burden of tracking site changes. However, the new infusion set is available in a few selected European countries starting with Finland and Belgium but is not approved for sale in the United States of America. 

How to choose the right infusion set for you?

Teflon vs Steel Cannula 

While soft cannula/Teflon cannula sets are popular due to ease of wearability and retention up to 72 hours, their flexibility can potentially disrupt insulin flow and lead to dangerously high blood glucose levels. Whereas steel cannulas provide better retention but for only 48 hours. The metal one is durable and useful for people who are allergic to Teflon. However, steel cannula can seem uncomfortable and require more frequent site changes. 

Method of Insertion 

During manual insertion, the person pushes the needle into the skin as if giving oneself an injection. The manual method allows patients to prepare psychologically for the task and achieve a less forceful insertion. People who are lean or like to control the speed of insertion opt for the manual method. On the contrary, insertion devices are helpful for people that have compromised motor skills, or needle phobia. Also, the insertion device facilitates faster pump insertion even in areas hard-to-reach infusion sites. However, a major limitation of the insertion device is that it needs to be administered correctly as the user must be known how to control the depth or exact angle of insertion while pushing the needle into the tissue.

Angle of Insertion 

A 90o angled set means the needle is inserted straight into the skin, which allows for use of a shorter needle. However, shorter needle tends to kink and become more dislodged easily. Whereas angled infusion sets are adapted by physically active or lean people due to less risk of kinking or dislodging but can be less appealing to people with needle phobia. 

Tubing 

The preference for tube length can depend on person to person depending on where you plan to insert your infusion set and where you want to wear the pump. 

Site selection

Most people prefer the abdominal area for consistent insulin absorption and the area is preferable even during pregnancy. However, other alternate insertion sites can be buttocks, thighs, hips, or arms. The arms and thighs have slower absorption rates, and the back of the arms have dexterity issues. So, people prefer hips and buttocks for alternate insertion sites due to comfort and moderate insulin absorption. 

Adhesive Patch 

People who engage more in physical activities should change their adhesive patches frequently to keep the set in place as they tend to perspire more. Some types of adhesive patches adhere better in wet conditions or are comfortable with people with sensitive skin. So, choose the adhesive tape that tends to suit your needs better and does not cause skin irritation. 

Conclusion 

Infusion set failure is a major limitation associate with insulin pumps, which can lead to diabetic ketoacidosis or prolonged hyperglycemia in type-1 diabetes. Despite major innovations, the infusion system failure rate is high therefore, key manufacturers of infusion systems need to develop more effective and less-risky infusion systems. However, the demand for infusion systems is set to grow in the coming years due to the rising prevalence of diabetes and the rapid adoption of portable healthcare devices. 

According to TechSci research report on “Global Self-monitoring Blood Glucose Market By Type (Type 1, Type 2, Hyperglycemia ,Hypoglycemia), By Frequency (One, Four, Others), By Product (Glucometer, Software, Test Strips, Lancet), By End-User (Hospital, Personal Care), By Region, Forecast & Opportunities, 2025”, the glucose self-monitoring blood glucose market is anticipated to grow at a significant rate owing to factors such as rising incidences of diabetic patients and faster diagnosis and treatment of diabetes. Growing geriatric population and major technological innovations are also anticipated to fuel the growth of self-monitoring blood glucose market.