Response from the Royal College of Physicians of Edinburgh PDF Print E-mail

Response from the Royal College of Physicians of Edinburgh to the Better Diabetes Care Consultation 22nd Aug 2009


Issues to consider

  • What further steps should be taken to increase the appropriate availability of insulin pumps?
  • What support structures need to be in place to ensure that insulin pump therapy is fully effective?

This is a complex therapy that is currently of benefit to less than 2% of the diabetes population in Scotland. As such, insulin pump therapy is probably greatly under-utilised in Scotland, certainly compared to comparable smaller countries such as Scandinavia. Over the last 25 years we have lagged behind, largely based on the cost of providing not just the technology but also the supporting infrastructure of Diabetologists and Nurse Specialists/Educators. Pump-led technology is moving on rapidly particularly with the development of sensors which are wirelessly linked to the pumps.

Arguably, the cost-benefit analysis of providing pump therapy now needs to look at the future costs of poor glycaemic control incurred by not providing more extensive access to pump therapy, rather than merely looking at the costs of pump therapy per se. The costs of pump therapy are modest in comparison to those of biological agents for conditions such as inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis and the like.

Explicit guidelines for the commencement and importantly, discontinuation of pump therapy, should be disseminated. Consideration should be given to developing a national system for both financing and procurement of pumps and consumables.

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