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- CSII, continuous subcutaneous insulin infusion
- DKA, diabetic ketoacidosis
- DSN, diabetic specialist nurse
- HCP, healthcare professional
- MDI, multiple daily injection
- QOL, quality of life
- T1D, type 1 diabetes
A growing option in the UK for children and young adults with type 1 diabetes
Insulin pump therapy—continuous subcutaneous insulin infusion (CSII)—was developed in the UK in the 1970s. Rapid technological developments changed the initial pumps from the size of a house brick, charged by mains electricity to an acceptable dimension, battery driven. We described the use of pumps in young people with type 1 diabetes (T1D) in the UK in Archives of Disease in Childhood in the early 1980s.1 While countries across the world, notably the USA, continued with pump development, the UK appeared to move away from CSII, following concerns about efficacy and safety,2 and the potential financial burden on the NHS. In the past decade technology has advanced and modern pumps are now small in size (matchbox), reliable, available, and relatively affordable. Many countries throughout the world use CSII as part of the modern management and treatment of T1D in children and young people, and large pump centres can be found in Germany, Holland, Belgium, and Scandinavia, as well the USA. Across all ages there are currently 20 000 pumps in use in Germany and 100 000 in the United States.3 At present the major centres in the UK (for example, Bournemouth and Harrogate) cater for a largely adult population, with small numbers of children and young people using insulin pumps.*
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Details of the insulin pumps currently available in the UK
CSII delivers a variable preprogrammable basal rate of fast/rapid acting insulin via a small indwelling plastic cannula, with insulin delivered as a background basal rate with bolus doses to cover the intake of carbohydrate containing foods, and to correct high blood glucose levels. This system of insulin delivery appears to offer not only improvement in metabolic control, but also increased physiological and …
Footnotes
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↵* There are several pump manufacturers worldwide. Currently, two UK based companies (Disetronic Medical and Medtronic) are servicing an estimated 1000 patients, with other companies entering the market (see table 1). The majority of these patients are adults with T1D. Experience of using pumps and training healthcare professionals (HCP) in their use in the UK is patchy across all patient age ranges. There are only a handful of centres with experience of providing young people (<18 years age) with pump training. The present official policy from the Department of Health on pump funding states: “Although pumps are not in wide use across the country, if resources allow, hospital consultants may prescribe insulin pumps as part of NHS treatment”. Funding of CSII in the UK, therefore, depends on where people live, and many families are fully funding all pump costs independently. Further information about funding and obtaining funding for CSII can be obtained from www.insulin-pumpers.org.uk/ukfunding. The National Institute for Clinical Excellence (NICE) published recently (April 2003) a Health Technology Assessment on insulin Pumps (“Diabetes – insulin pump therapy 57”), with recent “Guidance on the use of continuous subcutaneous insulin infusion for diabetes” (September 2003). See www.nice.org.uk.
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