Continuous subcutaneous insulin infusion: experience from a large specialist service

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Abstract The National Institute for Health and Clinical Excellence issued guidelines on continuous subcutaneous insulin infusion (CSII) in 2003 and has recently updated them. We present the findings of a retrospective study on CSII in a tertiary teaching hospital. Data were analysed on 85 patients established on CSII. The mean follow up was 24 months, 70% were female and the mean age was 40 years. Eighty‐two patients (96.5%) had type 1 diabetes, the mean duration of diabetes being 23 years, and NICE guidelines were followed for initiation in 78%. Patient satisfaction was assessed by Likert scale (‐3 to + 3) questionnaire. On CSII there was an improvement in HbA1c (mean [SD] 9.4[1.9] vs 8.6[1.5]%; [p<0.01]), with no significant change in weight. Severe hypoglycaemia decreased from 0.85 episodes/patient‐year to 0.08/patient‐year without an increase in diabetic ketoacidosis (0.20/patient‐year vs 0.09/patient‐year). Mean basal insulin requirement fell from 31(25) to 22(16) units (p<0.01). Thirty‐five out of the 85 patients had undertaken a DAFNE (Dose Adjustment For Normal Eating) course. After DAFNE, mean HbA1c fell from 9.2 to 8.9% (p<0.05), and then to 8.5% (p<0.05) after pump therapy. The response rate to the satisfaction questionnaire was 92%. Patients were happier on the pump compared to their previous treatment (mean score 2.5[2.3‐2.7 95% CI]). In the cohort of patients established on pump therapy, there was a significant improvement in glycaemic control, with an accompanying reduction in severe hypoglycaemia. Insulin pump therapy improves glycaemic control further in DAFNE graduates with no increase in severe hypoglycaemia. Patients were satisfied with pump therapy. Copyright ©2009 John Wiley & Sons, Ltd.

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