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n/a
Document type
Clinical policy
Place
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions
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Insulin Pumps

Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (interim)

Version 2.1 June 2024

Hertfordshire and West Essex ICB will routinely fund Insulin Pump therapy for adults and children 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.
Published: 23 July 2008

This update is an interim position in response to NICE TA943 on Hybrid Closed Loop Systems and NHSE 5 year implementation plan, pending a new policy/position statement on hybrid closed loop systems for children and young people. It ensures that children and young people identified within the highest priority groups as part of our HCL implementation plan are able to access pump therapy and therefore HCL.

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

CSII therapy is recommended as a treatment option for children and young people under 19 years with type 1 diabetes mellitus provided that: 

  • MDI therapy is considered to be impractical or inappropriate, or 
  • the young person is approaching transition to an adult diabetes team, or 

  • a child or young person is experiencing difficulties managing their diabetes (including but not limited to high HbA1c or disabling hypoglycaemia) 


1.3

It is recommended that CSII therapy be initiated only by a trained specialist team in secondary care (for children and adults), 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.

 

1.4

Following initiation in adults and children 12 years and older, 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.

 

1.5

CSII therapy is not recommended for the treatment of people with type 2 diabetes mellitus.


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/



 

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