Tuesday, 28 August 2012

Insulin pumps: an experiment or a solution?

Insulin pumps are being used increasingly in diabetes, and a comment made by someone with diabetes before they started using one got us thinking. They said that they had undergone so many discussions to make sure that they were suitable for a pump, that they were scared of what might happen if it didn't work for them. They felt pressured to make it work, and also got the feeling that they had a one-off chance of trying a pump, so if using it didn't go well they would never get the chance again.

Hearing this reminded us that insulin pumps are still not seen, in most diabetes teams at least, as a standard choice for the treatment of Type 1 diabetes. Despite the clarity of NICE guidance (NICE, 2008), people still have to undergo relatively rigorous assessments from their diabetes health professionals, and also insulin pumps are used in many cases as a 'last resort' rather than just one of the potential insulin delivery methods to choose from.

Why is this? Well, insulin pumps are regarded by many diabetes teams as an expensive luxury that should be reserved for a select few people with diabetes. However, expensive relative to what? Many long-term conditions have far more expensive investigations and treatments, including sophisticated scans and surgical procedures, and by comparison the 'routine' treatment for diabetes to keep people healthy and prevent complications is relatively cheap even when insulin pumps are included. They also have the added advantage of taking away the sheer tedium and public nature of insulin injections, two aspects that have such an impact on how people cope with having type 1 diabetes. In these cash-strapped NHS times, there is a danger of diabetes health professionals succumbing to the pressure to use the cheapest treatments rather than those that people might prefer long term if given a real choice.

So come on, the world of diabetes in 2012. Let's start putting insulin pumps in their right place - as a real choice for the majority of people with Type 1 diabetes, in common use in every diabetes team, with all health professionals trained and competent to use them.

To pump or not to pump? Let us know your thoughts…..

NICE (2008) Diabetes - Insulin pump therapy (TA151)