Aims and objectives: Continuous subcutaneous insulin infusion (CSII) has been in clinical practice since 1970s. NICE guidance (2008) recommends CSII in adults with type 1 diabetes (T1DM) if attempts to achieve target HbA1c with multiple daily injections (MDIs) result in disabling hypoglycaemia or HbA1c levels remain above 69 mmol/mol. The aim of our audit was to check compliance of our service against NICE guidance, and to see if CSII improved glycaemic control and/or hypoglycaemia in our patient cohort.
Methology: We conducted a retrospective audit of our adult pump service at West Suffolk NHS Foundation Trust. The service started in 2004. We considered the following audit parameters: Type of diabetes, indication for commencement of CSII, HbA1c at baseline and over 11 years, change in hypoglycaemia and use of other technology.
Results: We have 14.5% (n:161) of our patients with T1DM on insulin pumps. All patients on CSII were confirmed to have T1DM and fulfilled NICE criteria for pump initiation and continuation. Most common indication was hyperglycaemia followed by hypoglycaemia, pregnancy, dawn phenomenon and diabetic gastroparesis. HbA1c showed sustained improvement over 11 years period. Disabling hypoglycaemia also showed significant improvement.
Conclusion: Our CSII audit indicates compliance with NICE 2008 guidance, and shows sustained improvement in overall glycaemic control over 11 year period. There is a need to expand our service to offer CSII to more women with T1DM and poor glycaemic control during pregnancy and preconception period.