Guide to insulin pump therapy

Key statistics on diabetes estimates that up to one in twenty people in England have diabetes (diagnosed and undiagnosed). For adults it is estimated that 1 in 200 have Type 1 diabetes and that the current prevalence of Type 1 diabetes in children in the UK is approximately one per 700-1,000. Providing effective diabetes services accounts for a significant amount of NHS resource, and commissioners are going to have to work collaboratively with providers to ensure that diabetes services are continually improved in the wake of increased demand. Type 1 diabetes is a result of the pancreas failing to produce insulin. The objective of Type 1 diabetes treatment is to optimise blood glucose levels without increasing the risk of hypoglycaemia. Currently the treatment of Type 1 diabetes can be provided by multiple daily injection (MDI) therapy, whole pancreas transplantation, islet cell transplant or continuous subcutaneous insulin infusion (also known as insulin pump therapy).

A recent NICE 2008 Health Technology Assessment1 concluded that CSII is as clinically effective as MDI Therapy in improving glycaemic control and NICE estimates that it is likely to benefit 8% to 15% of adults and up to 50% of children under the age of twelve. Despite this policy guidance, however, adoption of insulin pump therapy is variable across the UK and it is reported that many areas of the country see less than 1% uptake of this technology. Compared to the rest of the world, the UK is significantly behind in terms of bridge gaps between both Primary and Secondary care and can improve clinical outcomes, patient experience and quality of life. Working alongside three clinical implementation sites, over an eighteen month period, the so-called “adoption barriers” were initially identified and overcome, leading to CSII therapy becoming the standard clinical option for patients within these health economies. Due to the NTAC project, CSII therapy is now being implemented as a routine treatment option at The Whittington Hospital NHS Trust, Birmingham Children’s Hospital NHS Trust and East Lancashire Hospitals NHS Trust. Two mentor Trusts have been working with these hospitals to ensure that implementation of the technology was a success, which included: Kings College London and Salford Royal NHS Foundation Trust, with Guy’s Hospital (Guy’s and St Thomas’ NHS Foundation Trust) acting as a Clinical Advisor site to the programme. Benefits (financial and non financial) of implementing this technology include:

• A reduction in emergency hospital admissions. Improved management of blood glucose levels (HbA1c) will reduce the risk of severe hypoglycaemia (symptoms of severe hypoglycaemia include collapse and coma) and/or diabetic ketoacidosis (DKA).
 • A reduction in planned hospital admissions and overall length of stay. Better diabetes management will lead to a reduction in inpatient supportive care.
• Delivering more cost effective treatment within the NHS. This is achieved through reduction in long-term complications and subsequent demands on health service expenditure.
• Higher quality services and support for patients. A systematic approach to implementation will deliver an enhanced clinical service.
 • Improved quality of life. Automatic control of insulin pump therapy has been shown to provide significant quality of life improvements and overall treatment satisfaction for patients.