With the advent of continuous subcutaneous insulin infusion therapy and the findings of the Diabetes Control and Complications Trial, the management of type 1 diabetes has changed drastically. Over the past 30 years since its development, the effectiveness of continuous subcutaneous insulin infusion has been assessed in comparison with other modes of intensive treatment. Additionally, improvements in pump delivery systems have been made. Here, the findings of the studies on pump therapy are reviewed. Selection criteria of patients for pump use and how to initiate pump therapy are presented. Finally, newer findings on continuous glucose sensors are discussed as the next era of pump therapy continues to focus on the goal of developing an artificial pancreas.