Insulin pump therapy, or continuous subcutaneous insulin infusion (CSII), was introduced in the 1980s. The goal of insulin therapy has moved from the initial aim of preventing deaths from diabetic ketoacidosis (the build-up in the blood of poisonous ketones due to lack of insulin) to delivering insulin in a more physiological way to prevent long-term complications, says Gregory.
Insulin pumps are controlled by a minicomputer, which can be programmed to release in the blood the required amount of short-acting insulin over a number of hours. They continuously deliver insulin via a catheter placed under the skin, at a rate that matches the body’s requirements, eliminating the need for multiple injections, also known as multi dose insulin (MDI) therapy.
Gregory notes that MDI and CSII differ in the way insulin is delivered, but the approach to diabetes management is similar. Both systems require the individual to count carbohydrates in meals, calculate insulin doses, and measure their blood glucose often. This enables them to self-manage the condition, which research shows is a key to effective diabetes control, however insulin is delivered.
Notably, in the UK only six per cent of people with type 1 diabetes use pumps, compared with over 15 and 40 per cent in Norway and the US, respectively. This is partly because pump therapy is not the first-line treatment for type 1 diabetes – the National Institute for Health and Care Excellence (NICE) recommend it for adults and children over the age of 12, whose diabetes is not well controlled with MDI treatment, says Gregory. Another factor is the lack of healthcare professionals with the skills to adequately support patients on pumps, as required by NICE guidelines.
Insulin pump technology, on the other hand, is advancing at a tremendous rate. There are bolus calculator meters that used in combination with pumps can calculate insulin doses, and continuous glucose monitoring (CGM) wearable devices that measure glucose levels under the skin every five minutes. New-generation insulin pumps are available that incorporate CGM technology. Called sensor-augmented pumps, “these devices can also trigger an alarm in case of hypoglycaemia, and switch off the insulin pump if the patient does not respond – a safety feature that could be of tremendous benefit,” says Gregory.
Lastly, the artificial pancreas (a totally closed-loop system that monitors blood glucose continually through a sensor placed under the skin and automatically delivers insulin as needed via an externally-worn pump) “is considered the holy grail of type 1 diabetes treatment, and is definitely approaching fast.”
Gregory says that the All Parliamentary Group for Diabetes is currently investigating ways to facilitate the introduction of innovative diabetes technologies. Incorporating these into the NHS is challenging but worthwhile, he adds. For one thing, it can help achieve equality of access, for novel technologies are marketed directly to patients, but not everyone can afford them. Additionally, providing technologies like CGM, for instance, means reducing the need for some patients to receive, on the NHS, costlier and riskier treatments, such as islet or pancreas transplantation.