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Continuous subcutaneous insulin infusion (CSII) is an increasingly popular modality for intensive diabetes treatment (IT). Appropriate patient selection is a key component for success with CSII. Current guidelines for patient selection are largely based on consensus or expert opinion. While most published studies have shown a modest but significant improvement in glycemic control when patients are switched to CSII, other studies have shown no benefit. One possible reason for this is patient selection criteria, ifmentioned at all, are significantly different. Any attempt at a comparison of existing studies may be confounded by the lack of patient selection criteria. This not only makes itdifficult to compare studies, but may introduce a bias into the conclusions that are reached. The selection of patients for CSII may depend as much upon the availability of a skilled and motivated team as on the patients themselves.

Aims Experimental models support a role for the sympathetic nervous system in bone metabolism. Beta-adrenoreceptors have been demonstrated on osteoblast-like cells. Beta-blocker use is associated with higher bone mineral density (BMD) in some epidemiologic studies. The aim of this study was to determine if measures of the autonomic nervous system (ANS) were associated with reduced BMD in type 1 diabetes. Methods We studied 66 individuals with type 1 diabetes. Dual-energy X-ray absorptiometry was used to measure BMD and bone mineral content (BMC). Measures of heart rate variability (HRV) (e.g., power spectral analysis, mean circular resultant) and circulating norepinephrine levels were used to evaluate autonomic function. Results BMD/BMC were examined by gender for individuals with a normal versus elevated low-frequency (LF) band (expressed in normalized units). No significant differences in BMD/BMC were shown for individuals with an elevated LF band. Direct-entry linear regression models with BMD/BMC as the dependent variable were performed. Duration, gender, BMI, HbA 1c , insulin dose/kg, activity energy expenditure, and measures of HRV were entered as potential independent variables. No measures of HRV, or norepinephrine, were independently associated with BMD/BMC. Conclusions The ANS, as assessed by measures of HRV, does not appear to impact BMD/BMC in type 1 diabetes.