Any studies on Insulin Pumps?

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Lee.Type1

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Afternoon All,

Does anyone know of any good studies (not nessasarily in thew UK) showing findings of how useful a insulin pump and or continuous blood glucose monitor is compared to manual jabbing and monitoing is?

I currently carb count and monitor on my own just fine and only just began to come close to the minimun HbA1c to meet the "NICE" standards for a pump, so just wanted to bring myself up to date before i brought this up with my diabetes care team and see thier thoughts, i know they will concentrate more on price more then anything so thought i would try and get the other side of the story if possible from here before i did anything else.

Looking at www.nice.org.uk/guidance/ta151 the last time this was reviewed was May 2011, surely there has to be much more information to review more often then this?

Lee
 
@Lee.Type1 As you probably know, HbA1C isn’t the only criterion for a pump. In fact, my HbA1C basically didn’t change when I got a pump. I don’t remember where I saw it, but a study showed that that’s not uncommon (HbA1C remaining basically the same). I got mine because no basal insulin matched my needs.

I mention that because all the studies in the world won’t necessarily show if a pump is right for you as an individual. It depends on your circumstances and your priorities and preferences. Some people love them, some would never have them. If you qualify to be offered one, then I’d advise researching as much as you can about what life is like with a pump. Compare that to your own lifestyle and to MDI. If MDI is working for you and you’re happy then you might not need a pump. There are pros and cons of both MDI and pumps, and we each weight those pros and cons slightly differently.

CGMs are a different matter, but, again it’s an individual preference. If you’re talking about looping then that’s something different again (and you might have to fund the CGM part of the loop yourself).
 
There used to be a charity called INPUT which focused on insulin pumps and diabetes technology.
They merged with JDRF a few years ago - that might be useful to investigate.

Regarding justifications to qualify for a pump, these do vary. Pumping requires more work to set up than injecting (it is much more than just carb counting) which means it is not right for everyone. My team require that you attend their equivalent of DAFNE. I believe part of this is to ensure you are willing to put in the effort and are able to understand the concepts of pumping.
For me, the main criteria was to minimise hypos whilst exercising (my HbA1C has changed very little) - I exercise a lot and was hypoing a lot. It is fantastic that I am now able to completely suspend my basal when I get on my bike or increase my basal when I go climbing.
I don't believe this is something that will be included in many studies.

My team were much less interested in price - they were more interested in my health and my ability to manage it with a pump.

As for CGM, do you mean CGM or do you mean Libre (Flash monitoring)? The NICE criteria for Flash are well documented (Google is your friend) and often comes out of a separate budget than "true" (usually more expensive) CGMs.
 
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I know Input (now part of JDRF) have done comparisons of the different pumps available and that this is regularly updated.

I went in to a pump because my basal insulin needs varied, and as I could set this hour by hour I was able to get a much closer match to what I needed. It eliminated virtually all night hypos, and was great for exercise as I could turn the basal down just an hour before starting, whereas on injections I needed to know what I was doing that day when I did my basal in the morning. My HbA1c did drop as I was reducing the spikes and drops. It does take some work to get it to match your needs, and needs regular adjustments. Having said that I would not want to go back onto injections.

Using the Libre had a bigger impact as it enabled to see the post meal spikes I was getting and to reduce these through pre-bolus ing. I also found exercising a lot easier and refined the adjustments that I made in the pump. It was this that dropped my HbA1c by 10.

More recently I have started to self fund a CGM sensor linked to my new pump, a Medtronic 780G. These ’talk’ to each other and make adjustments to basal insulin every 5 minutes. I no longer need to think about the background and now have a Time in range in the 80s and 90s a lot of the time. As a consequence I spend a lot less time thinking about Diabetes, which for me became an important consideration.
 
Hi Lee and welcome to the forum.
Your best approach for getting a pump if you want one is to show how in your eyes a pump would benefit you.

So if you know your basal insulin does not fit any of the basal insulin's you have tried, point this out to your team. Same for bolus if you have tried adjusting bolus and either spiking or going hypo point this out and explain that split or extended boluses would solve the problem.

There is no point what so ever showing your team pump research as they have already seen it more than likely 🙂
What matters is how a pump will help you personally. 🙂
 
TA151 is the binding document that guarantees access to pump therapy if you meet certain criteria.

What helps is having a supportive consultant (and DSN) who is convinced that it is the right option for you

Hypoglycaemia which occurs at random times and has persisted despite using analogue insulins and using modern intensive insulin therapy style strategies (eg DAFNE), and which causes the person with diabetes to worry (which I think one could argue is the case for most people aiming to keep BGs between 4-9) is the first criterion. This is because the better pump effectiveness data at the time was for reduction of hypos.

The second was an above 8.5% A1c despite the person doing their utmost with MDI. If I remember right the data suggested an average reduction of 0.5% which isn’t hugely impressive, but just about made the health-economic cut (perhaps because there was a spread of values, or higher values tended to see more effect).

There certainly have been many studies published in the meantime, including one (REPOSE) which showed that technology on its own was not the magic bullet. It needed to be matched with support too to maximise the effectiveness of the tech.

Additionally there will have been multiple studies into the emerging (and now growing) hybrid closed loop systems which integrate CGM to offer a degree of fine-tuning / automated assistance.
 
Really sorry to butt in to this thread. I'm looking at my upcoming pump exchange, I'm lucky to have already met the criteria.
I have quite individual requirements (don't we all), the pump I need (not a higher priced one) isn't on the list. How to get the trust/ccg to deviate from their standard choices, it's just a DANA RS so nothing far out
 
@Fatterthantheshadow in my experience, the decision is based on far more than the cost of the pumps. It is also the cost of training the staff in different pumps so they can support their patients and the bureaucracy of setting up relationships with the manufacturers.

My CCG support one pump only. This is a Medtronic. When I was coming up for a replacement (and patch one none specific) I pleaded for a patch pump and gave what I thought was good justification and was told there were no exclusions.
Thankfully, I was incredibly lucky. Soon after my begging request, my CCG were offered a trial of a “new” patch pump. As a result, I was offered the chance to be a guinea pig. i chose to stay with the pump but was close to losing it due to the problems of setting up Medtrum as an approved supplier. Two years later, I still have my Medtrum patch pump but I am self sufficient in terms of any problems as no other patients have the same pump.

Based on this experience, my advice would be to explain why you need the specific pump, expect to be declined and be willing to accept a different but similar pump.
 
You could mention the official loop trials as I believe they use the DANA RS. You could also mention the fact that they’re fantastic pumps but at a much better price than some.

If you’re looping yourself unofficially, you could say that the DANA RS guarantee actually includes looping and that it was developed with the help of the #wearenotwaiting diabetes community.

It’s the most popular pump at my clinic by miles, so maybe you could also mention it’s popularity.
 
Fatterthantheshadow said:
Really sorry to butt in to this thread. I'm looking at my upcoming pump exchange, I'm lucky to have already met the criteria.
I have quite individual requirements (don't we all), the pump I need (not a higher priced one) isn't on the list. How to get the trust/ccg to deviate from their standard choices, it's just a DANA RS so nothing far out
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Hope you manage to successfully make your case. Some centres only seem to offer a limited selection, and reasons offered vary from bulk purchase price reductions to lack of trained staff to support users on other brands.

Is there any chance you could be referred to a centre elsewhere which supports Dana? I know some people who are happy to travel quite long distances to attend a centre that meets their needs better.
 
@helli @everydayupsanddowns @Inka Thanks folks, after digesting your advice I'm formulating my approach. I do have a couple of alternatives, my exchange is near the end of 2021, the Insight pump officially still available and this was their prime choice in the past, they are fully trained up on this one still with lots of patients using it.
If I can't get a DANA RS more than happy with this one too, or even keeping my existing insight past warranty.
A great point about the link between DANA and #we'renotwaiting, if I do have to write to my ccg I'll be sure to include it.
At the end of the day I'm obtaining my best ever control, while the NHS can't endorse the DIY systems Patients using them are certainly controlling their condition
 
Lee.Type1 said:
Afternoon All,

Does anyone know of any good studies (not nessasarily in thew UK) showing findings of how useful a insulin pump and or continuous blood glucose monitor is compared to manual jabbing and monitoing is?


Lee
Click to expand...
Going back to the original question, how about Anita Jeyam and Fraser W. Gibb, 'Marked improvements in glycaemic outcomes following insulin pump therapy initiation in people with type 1 diabetes: a nationwide observational study in Scotland' in the June issue of Diabetologia, Volume 64, issue 6, June 2021, available open access at https://link.springer.com/article/10.1007/s00125-021-05413-7
 
Thanks everyone for your responses, i was really surprised how fast so many replies have accumulated!

@JohnWhi Thank you so much for the link, i'll look into the study!

I also wasn't aware of the difference between a CGM and a Libre flash, that is incredibaly useful information and from the sounds of it a CGM may be of more use to me than a pump, but i will need to think on it and research some more.

Reading everyones replies it seems what i need to do is look at my individual circumstances and make a case based on my own needs rather then just ticking the boxes per se, i will spend some time thinking about This before i contact my diabetes clinic but again thank you to everyone as this has been very informative for me. 🙂

Lee
 
everydayupsanddowns said:
Hope you manage to successfully make your case. Some centres only seem to offer a limited selection, and reasons offered vary from bulk purchase price reductions to lack of trained staff to support users on other brands.

Is there any chance you could be referred to a centre elsewhere which supports Dana? I know some people who are happy to travel quite long distances to attend a centre that meets their needs better.
Click to expand...
Can I ask a silly question, you talk about training staff for various devices, my son has been told to go and do his own research and contact the companies direct from the 6 devices our health authority will allow, to ask them to send him the devices direct to him to try out. At what point does the " trained staff"kick in as they are currently showing no interest at all in helping him ( latest conversation yesterday )
 
Jacqs96 said:
Can I ask a silly question, you talk about training staff for various devices, my son has been told to go and do his own research and contact the companies direct from the 6 devices our health authority will allow, to ask them to send him the devices direct to him to try out. At what point does the " trained staff"kick in as they are currently showing no interest at all in helping him ( latest conversation yesterday )
Click to expand...

That’s interesting… I think I was also told to do my own research and make my own choice.

I am not aware that device manufacturers can generally offer trial runs (it would be amazing if they did), though I know Omnipod offers dummy pods.

I was part of a group of bloggers who were given the opportunity to use the MM640G when that came out, but it needed the specific agreement of my hospital team, and for me to attend a face-to-face training with Medtronic as a part of their legal obligations. So I don’t think companies will just send out pumps and let you loose without training - at least that’s my understanding.

Different pumps suit different people, and everyone has their own sense of ‘must haves’ and ‘not bothered abouts’, so I can sort of understand why your son has been asked to make his own mind up. Would be nice for them to give a bit of a hand though!

Once he has made his choice, the training will kick in, with the fine details about set changes, sick day rules, temp rates, basal profiles, and all the rest.

Might be worth starting a thread with the choices available to see if there are members here using the same pumps, and have likes and dislikes about them to share?
 
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@Jacqs96 I can understand how intimidating it can be to be faced wit ha choice and little guidance.
I had a choice of one which took away the decision making but wasn't the best so when I came to replace it, I wrote a list of my requirements and starting looking at options.

Things I would consider are
- Size. Is the bulk of some pumps a concern to you and/or your son. This can affect whether it needs to be on display and whether it affects the tailoring of clothes and whether it is likely to be knocked.
- Controller. Do you mind taking it out to set a bolus or do you want to do so via a PDM or phone app?
- Cartridge. Some cartridges come pre-filled but most don't, Filling is a little fiddly but then you get to put as much as you want/need and there is less insulin waste.
- Volume. Most pumps come with a 200u cartridge but a few have a 300u cartridge. How much insulin will you use in 3 days?
- Minimum dose. How insulin sensitive are you? This is most relevant to basal doses which are "trickled in" in the smallest possible dose.
- Looping. You may not have the opportunity to get a CGM funded today but do you want the flexibility to self-fund and loop in the future?
- Tubes or not. I have had both. The fear of catching tubes on door handles or losing track of the pump in bed was never an issue over 4 years as it was so easy to tuck under clothing. There are more choices to place a cannula at the end of tube than the whole cross section of a tubeless pump. Tubed pumps can be completely removed during sport, for example. That said, I prefer my patch pump because it is more discrete and controlled via a phone app.

I am sure others will have thoughts but I am all for spreadsheets and scoring/notes for comparisons.
 
Apologies, I haven't been active in this thread for some time, I was made aware of this study about open source APS compared to Medtronic 670g loop system. I thought this would be the perfect place to share it

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