Diabetes (type 1) - insulin pump therapy

Summary

NICE has recommended insulin pump therapy as one option for people with type 1 diabetes provided that:

• multiple-dose insulin therapy (including using insulin glargine when it’s appropriate) has failed, and
• they are willing and able to use insulin pump therapy effectively.

NICE considers that multiple-dose insulin therapy has failed when someone has been carefully trying to manage their diabetes but hasn’t been able to keep their blood glucose levels within recommended levels without having ‘disabling hypoglycaemia’. This means that they have repeated and unpredictable hypoglycaemic episodes for which they need help from other people, and which make them anxious about the episodes occurring again and significantly spoil their way of life.

These recommendations about insulin pump therapy for type 1 diabetes are also valid for children, adolescents, pregnant women and women who are intending to become pregnant. However, pregnant women and women who are intending to become pregnant should only change to insulin pump therapy when under the care of the specialist team (see below). NICE does not recommend insulin pump therapy for people who have type 2 diabetes and need to take insulin.

Insulin pump therapy should only be started by a trained specialist team. This team should include a doctor who specialises in insulin pump therapy, a diabetes nurse and a dietitian (someone who can give specialist advice on diet). People starting on insulin pump therapy should be taught how to use the pump and should be able to get help from the team, especially when first starting the treatment.

People who have been using insulin pump therapy for some time should have their treatment reviewed by a specialist team. The team might decide to try current pump users with multiple-dose insulin treatment including insulin glargine, a long acting insulin-like medicine.

Documents

For healthcare professionals

• TA57 Diabetes (type 1) - insulin pump therapy: Summary
• TA57 Diabetes (type 1) - insulin pump therapy: Guidance

For patients, carers and the public

• TA57 Diabetes (type 1) - insulin pump therapy: Information for the public

Background information

• Review decision
• Review proposal
• Media Briefing: Guidance on the use of continuous subcutaneous insulin infusion for diabetes
• 2003/006 NICE issues guidance for diabetes, flu and stress incontinence to improve choice and care for NHS patients in England and Wales

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found