- RAG rating
- n/a
- Document type
- Clinical policy
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Policies & Evidence-based Interventions
- Document
- Download
Insulin Pumps
Insulin Pumps - Continuous subcutaneous insulin infusion for
the treatment of diabetes mellitus
v3.0
Hertfordshire and West Essex ICB will routinely fund Insulin Pump therapy for adults in line with the National Institute for Health and Care Excellence (NICE) Technology appraisal guidance [TA151] Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus.
Insulin pump therapy for children and young people (younger than 19 years) is routinely funded when recommended by the paediatric specialist diabetes team.
Where patients are eligible for insulin
pump therapy clinicians must choose the lowest cost device that is clinically
appropriate for the patient.
1 Recommendations
(Units for reporting HbA1c
have changed from % to mmol/mol since this guidance was published).
1.1
Continuous subcutaneous
insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment
option for adults with type 1 diabetes mellitus provided that either of
the following apply:
- attempts
to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections
(MDIs) result in the person experiencing disabling hypoglycaemia. For the
purpose of this guidance, disabling hypoglycaemia is defined as the repeated
and unpredictable occurrence of hypoglycaemia that results in persistent
anxiety about recurrence and is associated with a significant adverse effect on
quality of life.
- HbA1c levels have remained high (that is, at 8.5% [69 mmol/mol] or above) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care.
1.2
It is recommended that CSII
therapy be initiated only by a trained specialist team in secondary care, which
should normally comprise a physician with a specialist interest in insulin pump
therapy, a diabetes specialist nurse and a dietitian. Specialist teams should
provide structured education programmes and advice on diet, lifestyle and
exercise appropriate for people using CSII.
1.3
Following initiation in
adults, CSII therapy should only be continued if it results in a sustained
improvement in glycaemic control, evidenced by a fall in HbA1c levels, or a
sustained decrease in the rate of hypoglycaemic episodes. Appropriate targets for
such improvements should be set by the responsible physician, in discussion
with the person receiving the treatment or their carer.
1.4
CSII therapy is not routinely
funded for the treatment of people with type 2 diabetes mellitus.
This policy will be reviewed September 2026, or earlier if new guidance is published or as required as part of the local phased roll-out of NICE TA943: Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes, and NHSE HCL 5 year implementation strategy.
References
National
Institute for Health and Care Excellence (2008) [TA151] Continuous subcutaneous
insulin infusion for the treatment of diabetes mellitus. https://www.nice.org.uk/guidance/ta151/chapter/1-Recommendations
National
Institute for Health and Care Excellence (2023) [TA943] Hybrid closed loop
systems for managing blood glucose levels in type 1 diabetes https://www.nice.org.uk/guidance/ta943
NHSE (2024) Hybrid closed loop technologies: 5-year implementation strategy https://www.england.nhs.uk/long-read/hybrid-closed-loop-technologies-5-year-implementation-strategy/