ABCD position paper on insulin pumps

Insulin pump therapy is likely to be the most physiological form of subcutaneous insulin administration and has been shown to be of benefit particularly for type 1 diabetic patients who are unable to achieve good control of diabetes without suffering recurrent hypoglycaemic attacks. Whilst the National Institute for Clinical Excellence (NICE) estimated that such therapy should be made available to about 1% of type 1 patients (based mainly on studies done with older pumps and older insulins), experience from mainland Europe, Israel and USA suggests that 10–20% of patients are likely to benefit. Current NICE criteria also make it very difficult for children to qualify for such therapy, as they are unlikely to have tried MDI (multiple‐dose insulin therapy) to justify moving to pump therapy. The economic impact of the improved quality of life from pump therapy has also not been adequately considered, as some patients are able to return to work, or take fewer days off sick, and children may miss less time at school. There is now substantial new evidence which indicates that the availability of continuous subcutaneous insulin infusion (CSII) should be extended to a much broader group of those with type 1 diabetes than currently fulfil the NICE criteria. Furthermore, there are a number of specific indications for pump therapy where patient numbers are so small that there will never be clinical trial evidence to support the indication, but this should not preclude use of pump therapy in such circumstances where conventional treatments have failed. This paper summarises the latest evidence regarding the benefits of CSII over MDI and gives recommendations as to the place of CSII in therapy and the service implications.