Just 7% of 247,500 people with type 1 diabetes in the UK use insulin pumps, according to an audit backed by diabetes charities. Rates in other European countries were up to twice as high.
Insulin pump therapy can more tightly control blood glucose levels than daily injections, reducing the risk of complications such as blindness and amputation.
The report said too many patients were missing out because of a lack of specialist support services in the NHS. Charities called for better access to the devices.
NICE recommends insulin pump treatment where daily injections cause disabling hypoglycaemia, or when blood glucose remains persistently high despite treatment.
Consultant diabetologist and NICE fellow Dr Ian Gallen led an audit of UK insulin pump therapy use, backed by charities Diabetes UK and JDRF and by the Association of British Clinical Diabetologists.
His report, which used data from 97% of hospital trusts providing insulin pump therapy, found that use of the pumps in this country has risen in recent years.
But the UK still trails countries such as Germany and Norway, where around 15% of type 1 diabetes patients use the devices. In the US, about 40% of patients use an insulin pump.
Rates are better in the UK among children under 18, of whom 19% use an insulin pump, but again this falls behind other European countries.
The report linked poor uptake to a lack of healthcare professionals who are qualified to train patients to use the devices, particularly diabetes specialist nurses.
Dr Gallen said: 'Whilst the national picture is improving, we are still a good way from where we should be with pump treatment.
'The commissioners of diabetes services must study our audit so they can ensure they commission appropriate specialist diabetes services, meaning that people can quickly move to pump treatment when needed.'
Barbara Young, chief executive of Diabetes UK, said: 'While not everyone with type 1 diabetes wants a pump, it is important that those who would benefit and meet NICE guidance are able to access one, as pumps help some people to maintain a better level of blood glucose control than is possible through injecting insulin.'