Time to Initiation of Omnipod DASH® vs. Tubed Insulin Pump Therapy: A Time-and-Motion Study

There is currently a limited understanding of the process of initiating standard insulin pump therapy (IPT) and how this differs with pump type. A time-and-motion study was conducted in Germany and the United Kingdom (UK) to evaluate the time required for initiation with a tubeless insulin pump (a pod) versus other tubed pumps. The time taken to initiate patients onto tubeless IPT and tubed IPT (excluding automated insulin delivery systems, AID) was self-recorded by diabetes specialist nurses using a web-based tool. Pump users were adults with and without prior experience of IPT, and initiations were conducted face-to-face and remote. In 276 recorded initiations (112 tubeless, 164 tubed, 89% type 1 diabetes), the mean time for initiating tubeless IPT was 13 min shorter compared with tubed IPT, 118 min [standard deviation (SD): 94] vs. 131 min [SD: 109]; p < 0.001. There was a particular benefit in people transferring from multiple daily injections (MDI) and for all initiations in a face-to-face setting. People transferring from MDI in a face-to-face setting had the highest time saving with tubeless IPT (24 min per nurse per initiation, p = 0.001), and this was also substantial for people in the face-to-face setting from both MDI and prior IPT (15 min per nurse per initiation, p = 0.002). According to survey responses, nurses reported initiations on tubeless IPT to be as effective as on tubed IPT despite taking less time. This novel time-and-motion study identified significant time reductions for initiating tubeless IPT vs. tubed IPT. Applying these time savings across pump services could increase efficiencies for initiating IPT and reduce workloads. Further time-and-motion studies for IPT and AID initiations are needed. Improving access to insulin pump therapy for people with type 1 diabetes is a goal for many health systems, as inequalities in the adoption of this technology based on demographic and socioeconomic status continue to persist. These imbalances cannot be attributed to issues of funding alone. The ongoing use of insulin pumps requires support from healthcare professionals, and guidelines include recommendations that people should be initiated onto insulin pump therapy by specialist teams. Staff time and resources within pump services are finite and their availability can act as a barrier to adoption. The role that technology can have in improving the efficiency with which pump services can initiate people onto insulin pumps has received little attention in research. We have conducted a self-ethnographic study looking at the length of time it takes to initiate people and whether this can be impacted by the design of the pump, comparing the initiation time in real-world settings in Germany and the UK for tubeless insulin pumps (pod therapy) and tubed ones. This indicates that it could be possible to initiate someone onto a tubeless pump in less time than a tubed one, around 15–20 min per initiation on average. Applying these time savings across pump services could increase efficiencies for initiating insulin pump therapy and reduce workloads, potentially helping people to have access to this important technology.