NICE prescribes greater role for insulin pumps

Friday 25th July 2008

Patients with type 1 diabetes can be treated with insulin pumps when doctors believe conventional insulin injections are impractical or inappropriate, say new guidelines from the National Institute for Health and Clinical Excellence (NICE).

Insulin pump therapy is now recommended in adults or children aged 12 years or older with type 1 diabetes, if trials of conventional multiple daily injections have failed to control blood sugar levels (ie, if HbA1C levels have remained at 8.5% or above).

According to the latest estimates, 16,000 children aged 16 years or under in the UK are living with type 1 diabetes, and numbers are increasing. New figures released by Diabetes UK this month stated that last year there were more than 3,000 hospital admissions for children with type 1 diabetes.

Despite having the fourth highest incidence of type 1 diabetes in children across Europe, the UK has the lowest number of children attaining good diabetes control.

The new NICE guidance also takes account of the fear people with diabetes of all ages can experience from severe hypoglycaemic (dangerously low blood sugar) attacks, which can lead to coma and death.

NICE now recommends the use of an insulin pump in patients who suffer repeated and often unpredictable hypoglycaemic attacks, or where the patient is so worried that the fear has a negative impact on their life.

Research has indicated that insulin pumps help patients control their diabetes more effectively, which can reduce the harmful long-term effects of poor blood sugar control such as blindness, kidney failure and heart disease, and preventing hospital admissions due to hypoglycaemia.

Dr Fiona Campbell, Consultant Paediatric Diabetologist at Leeds Teaching Hospitals and a clinical expert advising NICE, said: "Using an insulin pump has made good control considerably easier to achieve. Insulin pump therapy should be considered a safe and effective alternative to multiple injections of insulin and can be started even as early as the point of diagnosis if this is clinically indicated.

"The publication of the new NICE guidelines will greatly support clinicians in their decisions to use insulin pumps to help patients manage their diabetes and we should expect to see insulin pump use in paediatric routine care to increase dramatically."

Andrew Dillon, NICE Chief Executive, said:  "People with type 1 diabetes need daily injections of insulin to survive. One of the main drawbacks of conventional insulin regimens is the difficulty individuals can have in constantly achieving blood glucose control and balancing the risk of disabling hypoglycaemia and hyperglycaemia – both of which can be potentially life threatening.

"Today's guidance means that people will continue to be able to access this important technology to achieve better blood glucose control, resulting in an improved quality of life and fewer situations where they need help from others."

NICE

"The new nice guidlines are good but unfortunately not carried out by either PCTs or diabetic consultants. I was told to consider a pump by my consultant 8 months ago and even though I carb count etc, have been told that they wont prescribe a pump for me until I have been on a DAFNE course which isnt in line with the NICE guidlines. All I have had is excuse after excuse as to why they cant get me on a pump at the moment and also that
they are only funding 8-10 pumps which again doesnt meet with the NICE guidlines that say if you meet the criteria you are entitled to a pump and capping should not happen but unfortunately it does and I think consultants are pressured to prescribe as few pumps as possible." - Geoff Cooper, Norfolk

"Yes fine for children challenging but useful and beneficial for the elderly as well" – V Henry, London