The UK service level audit of insulin pump therapy in adults

• Published in: Diabetic medicine Vol. 31; no. 4; pp. 412 - 418
• Main Authors: White, H. D., Goenka, N., Furlong, N. J., Saunders, S., Morrison, G., Langridge, P., Paul, P., Ghatak, A., Weston, P. J.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.04.2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Diabetes; Diabetes Mellitus, Type 1 - drug therapy; Endocrinopathies; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Guideline Adherence - statistics & numerical data; Humans; Hypoglycemic Agents - administration & dosage; Infusion Pumps, Implantable - utilization; Infusions, Subcutaneous; Insulin - administration & dosage; Insulin Infusion Systems - utilization; Medical Audit; Medical sciences; Practice Guidelines as Topic; United Kingdom; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; United Kingdom; Europe; United Kingdom > UK; Human; Obesity; Pancreatic hormone; Nutrition; Nutrition disorder; Metabolic diseases; Insulin; Audit; Treatment; Insulin pump; Adult; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12325

Aims The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first UK‐wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here. Methods All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the UK were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool. Results One hundred and eighty‐three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the UK, of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety‐three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0–8), mean whole‐time equivalent diabetes specialist nurses was 0.62 (range 0–3) and mean whole‐time equivalent dietitian services was 0.3 (range 0–2), of which 39, 61 and 60%, respectively, were not formally funded. Conclusions The prevalence of continuous subcutaneous insulin infusion use in the UK falls well below the expectation of NICE (15–20%) and that of other European countries (> 15%) and the USA (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users. What's new? This is the first UK‐wide service level audit of insulin pump therapy. The audit metrics were aligned to National Institute for Health and Clinical Excellence (NICE) technology appraisal 151. Of all UK insulin pump centres, 97.3% participated in the audit. The audit results provide up‐to‐date information regarding the number of people using insulin pump therapy and the prevalence of use amongst people with Type 1 diabetes in the UK. The audit outcomes identify a significant shortfall in the funding of healthcare professionals required to deliver pump services and explores the barriers to provision of insulin pump therapy in the UK.