Introduction To The Technology

Continuous Subcutaneous Insulin Infusion (CSII) or insulin pump therapy provides precise dosing of insulin with controlled steady delivery. A distinct feature of CSII is the use of a portable pump, a small external device that controls the infusion of insulin in a more flexible manner than conventional insulin injection regimes. Inside the device is a reservoir which contains insulin and this is attached to the body either via a piece of very thin tubing or via 'patch pump' technology. At the end of this tubing is a needle or "cannula" which is inserted under the skin, enabling the insulin to flow into the body. The insulin can be delivered at a set rate throughout the day, which can be increased when needed. The pump is not an automatic device, but it is designed to deliver insulin constantly, at varying rates which is programmed by patients. Patients also have the flexibility to deliver meal time 'boluses' of insulin.

The Technology in Use

The National Institute for Health and Clinical Excellence (NICE) recommends insulin pump therapy for some people with type 1 diabetes and estimates that it is likely to benefit 8-15% of adults and up to 50% of children under the age of 12.

For the use of this therapy following unsuccessful insulin injection therapy, and if patients are willing and able to use insulin pump therapy effectively go to summary sheet. It recommends that children under 12 should be offered insulin pump therapy if treatment with insulin injection therapy is not practical or considered appropriate.

NICE Technology Appraisal Guidelines are core standards within the NHS and have a key role in promoting high quality health care provision. Unless otherwise directed by the Secretary of State for Health, NHS organisations are legally required to provide funding and resources for treatments recommended by NICE, within 3 months of guidance publication.

There is considerable inequity in both access and provision of insulin pump therapy services and therefore compliance with NICE guidance across England and Wales. This may be in part due to differences in the interpretation of the NICE recommendations. Nevertheless, adoption of this therapy is variable across the UK and it is known that many areas have less than 1% uptake. The UK is significantly behind other parts of the world, where uptake is neaing 40% in some countries. It is often not recognised that the guidance also applies to children. A significant number of patients with type 1 diabetes that are eligible for insulin pump therapy treatment under the NICE recommendations are currently not benefiting from this therapy.

The evidence base section of this How to Why to Guide explains the NICE guidance in more detail.

NICE have produced a summary sheet which gives an overview of the guidance.
The full NICE guidance is also recommended for review.

What problems does it solve?

Optimal diabetes management can lead to a reduction in the overall costs associated with managing this long term condition, including a reduction in the on-going demands on healthcare services and the wider socio-economic impacts such as the ability to work.

Insulin pump therapy can play a pivotal role in improving the management of diabetes. Effective management has been shown to reduce the risk of complications, but when diabetes is not well managed, it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations leading to disability and premature mortality.

There are a number of specific problems associated with controlling diabetes through conventional treatment, including an increased risk of hypoglycaemia (which can lead to collapse and coma). This may be improved through a structured education programme. Using an insulin pump may also reduce the risk of severe hypoglycaemia.

Clinical and Patient Benefits

The development and improvement of insulin pump therapy services across the NHS will facilitate the delivery of improved diabetes management. This will contribute to a reduction in the number of emergency, planned and supportive care hospital admissions. Patients may also benefit from a lower HbA1c which improves overall quality of life and treatment satisfaction compared to patients using insulin injection therapy. A subsequent reduction in the risks associated with poorly managed diabetes will result in a reduction in the risk of long term complications with the potential to reduce healthcare costs and streamline the .

The Five Nations Trial reported improvement in all diabetes quality of life scores and perception of mental health with insulin pump therapy, compared to insulin injection therapy. Better general health, higher coping ability, lower anxiety and depression scores, greater freedom in eating and sleeping and greater family cohesion are also benefits that adopting this technology can bring to patients.

Our Benefits 'v' Barriers section compares the benefits with some of the perceived adoption barriers that may stifle adoption of this technology within the organisation.

Our 'Who Benefits Guide' gives an essential overview of the benefits that can be achieved.

Providers of the Technology

There are currently several providers of the insulin pump. Whilst it is not NTACs role to recommend specific manufacturers, the Procurement Section of this How to Why to Guide explains the options available to Trusts for purchasing this technology and any associated consumables.