Endocrine Abstracts

Background: Long-term insulin therapy is associated with considerable side-effects. Tight control of blood glucose is vital to minimise risk of complications and to maintain quality of life. Insulin pump therapy (or continuous subcutaneous insulin infusion-CSII) can improve glycaemic control without consequent increased episodes of hypoglycaemia. It has been available for many years but it has only recently begun to be a treatment of choice for type 1 diabetes in the UK. CSII offers several pharmacological advantages. Only one type of insulin (short acting analogue) is used which is continuously delivered in minute doses. This eliminates both problems associated with interactions of insulins and eliminates large subcutaneous insulin depots. The 24h profile also allows for correction for Dawn phenomenom. Insulin Pump Suppliers: Initially there was only one type of pump available in the UK (Disetronic) but currently there are three companies supplying pumps within the UK (Medtronic, Roche and Animas). The relevant advantages/disadvantages of the different systems will be discussed NICE guidance and pump funding: Previously, patients within the UK had to purchase their insulin pump (£2,000+) and the consumables (infusion sets and reservoirs) as these were not available on the NHS. The National Institute for Clinical Excellence (NICE) issued guidance in February 2003 to the NHS in England and Wales on the use of CSII for diabetes. Although in theory this means that patients who fulfil the criteria laid down in the guidance should receive funding for their pumps, there is still a great heterogeneity of implementation of the guidance nationwide. Primary Care Trusts receive significant government funding for the implementation of NICE guidelines, but there is still widespread reluctance to accept the available evidence supporting the benefits of pump therapy. Organisations such as INPUT (insulin pump therapy) exist to aid both patients and clinicians in obtaining insulin pumps and appropriate funding.