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New guidance on insulin pumps issued

The National Institute for Health and Clinical Excellence (NICE) have issued revised guidance for insulin pump therapy for people with diabetes.

People with Type 1 diabetes aged 12 years or over could have access to insulin pump therapy if they are experiencing “disabling hypoglycaemia” or have an Hba1c of 8.5 per cent or greater whilst using multiple daily injections (MDI) despite trying to achieve good control.  Children under 12 with Type 1 can have access to insulin pump therapy if MDI are considered impractical or inappropriate. However, once they reach the age range of 12–18, they will be expected to have a trial of MDI if they did not do so prior to starting to use a pump.

Diabetes UK and INPUT statement

In response to the new guidelines, Diabetes UK and INPUT have issued the following statement:

“Diabetes UK and INPUT believe that the newly issued NICE guidance on insulin pump therapy for people with diabetes is a step forward in increasing access to insulin pumps for people with Type 1 diabetes. We are pleased to see that new, less stringent eligibility criteria will mean that children with Type 1 diabetes under the age of 12 may not have to have a trial of multiple daily injections (MDI) before being offered the choice of pump therapy.

Not as progressive as hoped

However the guidance is not as progressive as Diabetes UK and INPUT would have hoped, and specifically we are extremely disappointed that cost effectiveness considerations have created eligibility criteria that could be seen as a perverse incentive against good blood glucose control. People with Type 1 diabetes aged 12 and over who are not experiencing disabling hypoglycaemia and have an Hba1c of less than 8.5 do not meet the criteria for an insulin pump. This does not consider the quality of life benefits that an insulin pump may bring to some people with diabetes even if their control is at a level below 8.5.

Concerns

We are also concerned that children under 12 who are enabled to have a pump without a trial of MDI will be required to have this trial at some stage between the ages of 12 and 18. Diabetes UK and INPUT believe this could compromise the care and quality of life of those who are doing well on a pump. Decisions about treatment alterations must be reached between a healthcare professional, the child and their carers and this decision making process must be respected by PCTs.

Access based on needs

When it comes to general access to insulin pumps, Diabetes UK and INPUT believe that the devices should be available to people with diabetes based on individual clinical need, personal choice and suitability rather than based on cost considerations. PCTs must ensure that they make funds available to enable all people with diabetes who meet the criteria for pump therapy to have access to an insulin pump. Guidance surrounding implementation needs to ensure that there is not another post code lottery of provision. It is clinicians and people with diabetes who must jointly agree that insulin pump therapy is a suitable treatment choice, and PCTs must respect the decisions that clinicians make.”

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