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Review: Continuous subcutaneous insulin infusion therapy and children with type 1 diabetes mellitus: the 2008 updated NICE guidelines
David Kerr
The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK, david.kerr{at}rbch.nhs.uk
Approximately 25,000 children and young people live with type 1 diabetes in the UK. Their high risk of long-term complications is compounded by the problematic management of diabetes in children. CSII (continuous subcutaneous insulin infusion), or `insulin pump', therapy has the potential to improve glycaemic control, reduce the frequency of severe hypoglycaemia and improve quality of life, but is presently underused. NICE (National institute for Health and Clinical Excellence) now recommends CSII as a treatment option for adults and children aged 12 years or older with type 1 diabetes, when MDI (multiple daily injection) insulin therapy results in disabling hypoglycaemia or fails to reduce HbA 1c levels below 8.5%, and for children aged under 12 years whenever MDI therapy is impractical or inappropriate. These new recommendations are likely to increase the use of CSII across the UK. Accordingly, healthcare providers will need to integrate this modality routinely within a cohesive service for adults and children with diabetes. As CSII therapy should be initiated only by a specialist team (normally comprising a physician with a special interest in CSII, a diabetes specialist nurse and a dietician), improving access to accredited staff training is a priority.
Key Words: continuous insulin infusion • diabetes mellitus • insulin • paediatrics • pump
References
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The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 1 suppl,
S2-S5 (2008)
DOI: 10.1177/1474651408097727
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