This guidance replaces 'The clinical effectiveness and cost effectiveness of insulin pump therapy' (NICE technology appraisal guidance 57) issued in February 2003. For details, see 'About this guidance'.
Units for reporting HbA1c have changed from % to mmol/mol since this guidance was published. The NICE Pathway on diabetes has been changed to reflect this.
1.1 Continuous subcutaneous insulin infusion (CSII or 'insulin pump') therapy is recommended as a treatment option for adults and children 12 years and older with type 1 diabetes mellitus provided that:
attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life
HbA1c levels have remained high (that is, at 8.5% [69 mmol/mol] or above) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care.
1.2 CSII therapy is recommended as a treatment option for children younger than 12 years with type 1 diabetes mellitus provided that:
MDI therapy is considered to be impractical or inappropriate, and
children on insulin pumps would be expected to undergo a trial of MDI therapy between the ages of 12 and 18 years.
1.3 It is recommended that CSII therapy be initiated only by a trained specialist team, which should normally comprise a physician with a specialist interest in insulin pump therapy, a diabetes specialist nurse and a dietitian. Specialist teams should provide structured education programmes and advice on diet, lifestyle and exercise appropriate for people using CSII.
1.4 Following initiation in adults and children 12 years and older, CSII therapy should only be continued if it results in a sustained improvement in glycaemic control, evidenced by a fall in HbA1c levels, or a sustained decrease in the rate of hypoglycaemic episodes. Appropriate targets for such improvements should be set by the responsible physician, in discussion with the person receiving the treatment or their carer.
1.5 CSII therapy is not recommended for the treatment of people with type 2 diabetes mellitus.