Continuous subcutaneous insulin infusion (CSII) for type 2 diabetes mellitus (T2DM) is a promising therapy, but the clinical evidence supporting it is mixed. Large randomized controlled trials have concluded that CSII was equivalent to multiple daily injections (MDI), whereas smaller trials have concluded that CSII was superior. Simpler insulin regimens of CSII have been investigated for T2DM and may lead to improved outcomes. Future directions in this area include simpler insulin pumps and the use of concentrated insulins (U-500), neither of which has left the feasibility stage of research. CSII may be appropriate for some people with T2DM, especially those for whom MDI therapy has failed.