Evaluation of the benefits of a structured insulin pump start pathway

Background: In 2011, the Scottish Government provided substantially increased funding to increase the availability of continuous subcutaneous insulin infusion(CSII) in Scotland. In order to support the increased numbers of CSII users in our service, we set up a structured process (September 2013) to deliver the required education, training and follow up. Patient who have undergone structured education, referred for pump therapy are invited to an awareness session, followed by comprehensive pre‐assessment by dietitian, diabetes specialist nurse and psychologist. Patients proceeding to pump therapy, have a series of pre‐arranged sessions including Saline start, insulin start, one week, one month and three month follow up.

Methods: In this audit we have compared outcomes between patients who underwent the structured process (Group‐2) to those who did not (Group‐1). A retrospective records review was carried out for care information just before and one year after CSII.

Results: There were 45 patients (17 men, 38yrs (SD 11)) in Group‐1 and91 (38 men, 39 years(SD13)) in Group‐2. Group‐1 had a lower initial HbA1c of 72.2mmol/l(SD 15.6) compared to Group‐2 (72.4, 13.7). However there was greater fall in HbA1c in Group 2 (11.6mmol/l; SD12.1) than group 1(4.1;SD12.2). Only 12 (27%) patients achieved HbA1c below 58mmol/l after CSII in group 1 compared to 31 patients(34%) in Group‐2. The proportion of patients starting CSII for problems with hypoglycaemia was lower in group‐2 (24%) from 33% in group‐1.

Conclusion: A structured insulin pump start pathway is an effective method of commencing patients on CSII therapy