Yes!
However, obtaining an insulin pump on the NHS is not as simple as seeing your GP and asking for it. Sometimes a doctor or diabetes specialist nurse (DSN) first suggests that a patient might benefit from a pump; some people are considered for a pump after asking their diabetes consultant or DSN about it. However, before a pump can be prescribed, the patient (or the patient”s carer), the GP, and the diabetes consultant must all agree that a pump is the way forward.
In order to receive a pump and pump supplies bought by the NHS, patients must meet certain criteria. The 2008 National Institute for Health and Clinical Excellence (NICE) technology appraisal on insulin pump therapy says:
Continuous subcutaneous insulin infusion or “insulin pump” therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if:
- attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDI) result in the person having “disabling hypoglycaemia”. For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life.
OR
- HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes.
Regarding children in particular, the NICE guidance says:
CSII therapy is recommended as a treatment option for children younger than 12 years with type 1 diabetes mellitus provided that MDI therapy is considered to be impractical or inappropriate.
The NICE guidance does not mean that a person”s HbA1C must be higher than 8.5% in order to have a pump. It mentions 8.5% because when person has an HbA1C level of 8.5% or higher, he or she is likely to require much more care from the NHS than is usually needed by someone with an HbA1C below 8.5%. Based on the results of the DCCT, most doctors now agree that it is best for all people with diabetes to keep an A1C level below 7% to prevent or delay complications of diabetes.
Also, it is important to note that severe Hypoglycaemia is not only when an ambulance is called or a person needs glucagon. According to the NICE guidance, needing help from another person to treat a hypo or being unable to do daily activities because of hypos, or fear of hypos, means Hypoglycaemia is disabling.
The NICE guidance is intended to help doctors, patients, and PCTs understand when a pump may be appropriate for a given patient. The final decision whether to go on a pump rests with the diabetes specialist (“diabetologist” or “diabetes consultant”) and the patient. If a diabetologist recommends insulin pump therapy, a PCT cannot refuse to fund insulin pump therapy on grounds of cost. PCTs are also not allowed to create “waiting lists” for pump therapy. Anyone who has heard from a PCT employee rather than a practicing doctor that he or she is not eligible for a pump, or who has been placed on a “waiting list” to begin insulin pump therapy, is invited to contact INPUT for advice.
The Secretary of State for Health expects that PCTs will pay for insulin pump therapy for all patients for whom a pump is recommended by a doctor. Anyone who is self-funding their own insulin pump therapy is requested to contact INPUT for advice on whether they may be entitled to PCT funding.
Regarding “niche indications” (see Is it right for me?), INPUT put the question about funding to Dr Peter Hammond, Consultant in Diabetes & Endocrinology at Harrogate District Hospital.
We asked “How successful are you with obtaining funding for the niche indication patients who don’t strictly fit the NICE criteria?”
He said “I think we are fortunate in that we have a large number of patients on pump (about 150) so an occasional patient started on pump therapy for a niche indication is not really an issue. However if we do need to persaude our commissioners we can give a 3 month trial of pump therapy with specific targets to be achieved, either in terms of control or other issues, eg use of enteral feeds in gastroparesis, and then approach the commissioners with the evidence that pump therapy has been successful. We have certainly used this approach successfully in obtaining funding for sensor-augmented
pump therapy.”
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