OBJECTIVES: NICE technology appraisal TA151 (Continuous subcutaneous insulin infusion [CSII] for the treatment of diabetes mellitus) was issued in July 2008, replacing TA57 from February 2003 and recommending uptake of CSII pumps in (1) adults with type 1 diabetes mellitus (T1DM) who fail to reduce HbA1c <8.5%, or disabling hypoglycaemia using multiple daily injections (MDI), (2) and children without requiring previous MDI-failure. CSII uptake in the UK rose to 4% between 2003–2008 and to 6% between 2008–2013. It still lags behind NICE’s 2008 benchmark of 12%, in addition to uptake in other Western countries. We aimed to understand why the UK has comparatively low pump uptake. METHODS: We performed a structured PubMed literature review using search terms “Continuous subcutaneous insulin infusion” AND glycaemi* OR hypoglycaemi* OR “costs and cost analysis[MeSH]”, published after 01/01/2008. Captured articles were sifted; excluding irrelevant articles, or those not in English. Other relevant reports were captured by horizon scanning. RESULTS: Our search terms captured 113 articles. Reviewing reports meeting the inclusion criteria revealed that since 2008, additional studies contribute evidence supporting CSII efficacy in improving HbA, glycaemic variability and incidence of hypoglycaemia compared to MDI; in addition to being well-tolerated by patients. Recent cost-analyses suggest that CSII remains cost-effective, especially when increasing baseline HbA, hypoglycaemia avoidance, or pump life expectancy. Furthermore, there may be a low availability of specialised nurses, dieticians and other clinicians that NICE recommends are required to form part of a CSII-specialised multi-disciplinary team. CONCLUSIONS: It is surprising that given the amount of evidence supporting the efficacy, safety and cost-effectiveness of CSII, uptake of pumps by T1DM patients remains low in the UK. It is interesting that current evidence may be undermined by poor availability of clinical staff specialised in CSII, thus preventing new patients from effectively managing their condition.