NICE Guidelines & Funding for Insulin Pump Therapy

NICE Technology Appraisal guidance No. 57 states:

Continuous subcutaneous insulin infusion (CSII or 'insulin pump therapy') is recommended as an option for people with type 1 diabetes provided that:

• multiple-dose insulin (MDI) therapy (including, where appropriate, the ue of insulin glargine) has failed; and
• those receiving the treatment have the commitment and competence to use the therapy effectively.

People for whom MDI therapy has failed are considered to be those for whom it has been impossible to maintain a haemoglobin A 1 c level no greater than 7.5 in the presence of microalbuminuria or adverse features of the metabolic syndrome) without disabling hypoglycaemia occurring, despite a high level of self care of their diabetes. 'Disabling hypoglycaemia', for the purposes of this guidance, means the repeated and unpredictable occurrence of hypoglycaemia requiring third-party assistance that results in continuing anxiety about recurrence and is associated with significant adverse effect on quality of life.

CSII therapy should be initiated only by a trained specialist team, which should normally comprise a physician with a specialist interest in insulin pump therapy, a diabetes specialist nurse and a dietitian.

All individuals beginning CSII therapy should be provided with specific training in its use. Ongoing support from a specialist team should be available, particularly in the period immediately following the initiation of CSII. It is recommended that specialist teams should agree a common core of advice appropriate for CSII users.

The recommendations in this guidance are also applicable to children, adolescents, pre-pregnant and pregnant women for whom MOl therapy is deemed to have failed. Because of the risks of ketoacidosis to the fetus, pregnant or pre-pregnant women who switch to CSII therapy should do so only on the advice and under the care of a specialist team (defined in Section 1.3).

CSII therapy is not recommended for people with type 2 diabetes who require insulin therapy.

Established users of CSII therapy should have their insulin management reviewed by their specialist team so that a decision can be made about whether a trial of a switch to MOl incorporating insulin glargine would be appropriate.

Click here for the full NICE Guidelines for Insulin Pump Therapy.