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Pump treatment is more expensive than multiple daily injections, with pumps costing around 2500 ($3041; 2800) each plus 1500 a year for consumables (cannulas, reservoirs, and batteries).7In the UK, pump use is approved in adults with type 1 diabetes who have high glycated haemoglobin (HbA1c) values (>8.5%) or an inability to achieve reasonable control without “disabling hypoglycaemia.”8 An estimated 6% of UK adults with type 1 diabetes use pumps, which is lower than in many comparable countries.9 Around 40% of people with type 1 diabetes in the USA use High Quality replica Bags pumps,10 and proponents of pumps suggest that far more people should be offered them in the UK.11One weakness of existing evidence is that patients allocated to pumps are likely to have received more training and attention than those using multiple daily injections. A recent observational study12 of pump treatment and injections, where both groups received intensive education in insulin usage, concluded that the training might have made the most difference. To our knowledge, no randomised trials in adults have compared pump treatment with multiple daily injections where the same structured training in insulin adjustment has been provided, so the added benefit of pump technology remains unclear.In the Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial we assessed the effectiveness of adding pump treatment to high quality equivalent structured education in flexible intensive insulin treatment for people with type 1 diabetes, comparing pump plus education with multiple daily injections plus education.

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