Introduction: Continuous subcutaneous insulin infusion (CSII) or pump, therapy is used for intensification of insulin therapy. NICE guideline 2008 recommends CSII as an option for adults / children 12 years or older with insulin dependent diabetes mellitus (IDDM), when multiple daily injection (MDI) insulin therapy results in disabling hypoglycaemia/fails to reduce HbA1c levels below 8.5%, and for children below 12 years whenever MDI is impractical or inappropriate. Nevertheless, the cost implications are high in terms of equipment and time. This retrospective audit looks into the effectiveness of pump service in a DGH and compliance with NICE guidance.
Methods: Children 016 years with IDDM on CSII attending paediatric diabetes service in Singleton Hospital (20072011) were identified. Data were collected from the diabetes database, notes and pathology system.
Results: Of the 165 children with IDDM attending our service, 30 patients were on CSII during this period. (one lost pump). 24/29 patients improved their HbA1c (mean difference, 1.5%; best, 5.1%). Mean HbA1c of the group pre pump was 9.28% and post pump was 8.05%, with mean improvement of 1.2%, P<0.0001 (95% CI 0.641.754). Mean HbA1c of the non pump patients was 9.03% (P=0.0089; 95% CI 0.2581.762). 14/29 patients had improvement of hypoglycaemia (moderate/severe). Hyperglycaemia admissions to hospital were 81%. We identified 23 patients who were not quite meeting the HbA1c outcome targets and few patients over 12 years have had pump holidays.
Conclusions: There was a significant improvement in HbA1c with CSII therapy. It was not possible to quantify a quality of life improvement in this audit. As a service development, we aim to develop a virtual pump clinic.
09 - 11 Nov 2011
British Society for Paediatric Endocrinology and Diabetes