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Executive Summary

Executive_Summary_Section-CSII

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Diabetes in the UK 2010: 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 one in two hundred have type 1 diabetes and that the current prevalence of type 1 diabetes in children in the UK is approximately one in 700-1,000. Providing effective diabetes services accounts for a significant amount of NHS resource, and commissioners must work collaboratively with providers to ensure that diabetes services are continually improved in the wake of increased demand.

The results of this technology implementation project demonstrated that there are major challenges with successfully embracing Continuous Subcutaneous Insulin Infusion (CSII, also known as Insulin Pump Therapy), a NICE approved technology for some people with type 1 diabetes, which has now become a routine treatment option for patients in NTAC's three implementation sites.

This How to Why to Guide aims to provide practical guidance to enable the successful implementation of insulin pump therapy and to release the benefits a pump service can bring. The guide has been specifically designed to save you time, improve patient outcomes and enhance overall productivity. It will be beneficial to Trusts who currently provide, or plan to provide, an insulin pump therapy service.

In this guide you will find:

  • Clinical evidence to help you understand more about insulin pump therapy.
  • Support to put together a business case which will guide the commissioning process.
  • The roadmap to pump service implementation and the necessary supporting policies.

The guide also includes useful information which will assist NHS organisations in developing this service, based upon the work of NTAC implementation sites which include:

  • An Introduction to insulin pump therapy.
  • The benefits of adopting the technology.
  • Overcoming perceived barriers to adoption and realising the benefits.
  • Lessons Learnt by NTAC's clinical implementation sites.
  • How to effectively produce or purchase or purchase pump therapy technology and associated consumables.
  • Key Policy Section areas that will be impacted on as a result of implementation.

The Technology Explained

CSII or insulin pump therapy provides precise dosing of insulin with controlled steady delivery. A distinct feature of CSII therapy is the use of a portable pump, a small external device that controls the infusion of insulin in a more flexible manner than conventional injection therapy. It delivers continuous fast acting insulin from a reservoir via a needle inserted under the skin, through a soft thin tube or via 'patch pump technology'. It provides patients with an option to deliver insulin to accommodate food to be eaten or reduce raised blood glucose levels. This flexible method of insulin delivery can help to improve diabetes control in insulin-deficient type 1 diabetes.

The impact of poorly controlled diabetes on those patients who could otherwise benefit from an insulin pump signifies a huge burden on the health economy. The National Institute for Health and Clinical Excellence (NICE) has recommended insulin pump therapy as one option for people with type 1 diabetes as part of a cohesive and comprehensive diabetes service. The NICE guidance recommends the use of this therapy in patients where insulin injection therapy has failed, if patients are willing and able to use insulin pump therapy effectively. It recommended that children under 12 should be offered insulin pump therapy if treatment with insulin injection therapy is not practical or considered appropriate.

Our evidence base section details all the relevant and supporting evidence for insulin pump therapy.

Key Benefits of the Technology

  • A reduction in emergency hospital admissions. Improved management of blood glucose levels (HbA1c) will reduce the risk of severe hypoglycaemia (signs 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. Better overall control will reduce the incidence of long term complications and supportive care.
  • 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 therapy has been shown to provide significant quality of life improvements and overall treatment satisfaction for patients.

Click here to be taken to the Benefits vs. Barriers section of this How to Why to Guide.

This will compare some of the perceived adoption barriers within the organisation and how they may hinder uptake of this technology.

Impact on Key Policy Areas

The Diabetes National Service Framework (NSF) and the National Institute for Health and Clinical Excellence (NICE) Technology Appraisal Guidance for insulin pump therapy, both support an integrated evidence base approach to delivering best practice diabetes care. A number of notable standards relating to children were developed to ensure their specific needs are met. Despite this policy guidance, 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. The UK is also significantly behind other parts of world, where uptake is nearing 40% in some countries.

The Policy Section of this How to Why to Guide discusses policy in more detail and provides documentation and supporting resources for Trusts that you may find helpful.

Summary of Clinical Evidence

The National Institute for Health and Clinical Excellence has made clear recommendations for the use of insulin pump therapy for people with type 1 diabetes as part of a cohesive and comprehensive service.

Click here to be taken to the evidence base section of this How to Why to Guide, which will explain the evidence base in more detail.

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