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Re: [IPk] Pump Funding Criteria



Hi folks

Diabetes UK refers people who contact the Careline with a question about
insulin pumps to INPUT (www.inputdiabetes.org.uk), which is great because
insulin pump access and funding fall under INPUT's remit :) .

NICE Technology Appraisal 151 on insulin pump therapy (2008) states in
section 1.4: 'Following initiation in adults and children 12 years and
older, CSII therapy should only be continued if it results in a sustained
improvement in glycaemic control, evidenced by a fall in HbA1c levels, or a
sustained decrease in the rate of hypoglycaemic episodes. Appropriate
targets for such improvements should be set by the responsible physician,
in discussion with the person receiving the treatment or their carer.'

Unfortunately some diabetes teams start people on pumps without clearly
identifying the goals of therapy and without supporting patients in
achieving these goals.

In such cases, INPUT's usual advice is to change hospitals, to go to a
different clinic that may be better equipped to help someone succeeed on a
pump. In England patients can change hospitals by asking for a referral
from their GP. INPUT maintains a list of pump clinics we hear good things
about at http://www.inputdiabetes.org.uk/alt-insulin-pumps/pump-clinics/

If the only thing a diabetes team can suggest to improve someone's control
is 'stop using the pump' then getting an MP to write the hospital to say
someone should still have a pump isn't going to do a blessed thing to help
someone get better control - changing teams is more likely to result in a
different outcome.  As attributed to Einstein: 'The definition of insanity
is doing the same thing over and over again and expecting different
results.'

All best

Melissa
Type 1 19+ years; pump user 17+ years; INPUT Chief Adviser




On Fri, Dec 6, 2013 at 10:53 AM, Barbara Roberts <email @ redacted
> wrote:

> Ludicrous!  It seems to me that they are thinking of a pump as say a course
> of antibiotics - take them, get  better and stop - rather than say tablets
> for high blood pressure or underactive thyroid where you need to keep on
> taking the tablets...
>
> I am sure Diabetes UK would be helpful. Perhaps also the local Healthwatch?
>
> Good luck
> Barbara R
>
>
> On 5 December 2013 18:14, Suzanne Allen <email @ redacted
> >wrote:
>
> > I went to see the Diabetic Nurse at my local hospital today and asked her
> > about pump funding.  She told me that whereas pumping funding used to be
> > decided every four yours, the life of the pump, it is now decided
> > annually!!
> > The decision about whether further funding will be made for a patient
> rests
> > in the hands of a non-clinician! Why?  This person is only interested in
> > HbA1c results regardless of the health benefits you may have reaped from
> > being on the pump!  So it doesn't matter that I haven't had background
> > retinopathy for the last three years, only what my HbA1c is!  Apparently
> > this person wants to see improvements with each 6 monthly review.
>  Though I
> > imagine there must be a point at which you can't improve much more.
> >
> > I can understand funding being withdrawn if patients don't really make
> any
> > progress with their pump, but where people have improved their score
> since
> > they were on the pump, this should be taken into account even if they
> don't
> > reach the gold standard.
> >
> > I really think that Diabetes UK should know about this and put up a fight
> > on
> > our behalves.  I intend to write to them to apprise them of the
> situation.
> >
> > Anyone got any thoughts on the above?
> >
> >
> >
> > Suzanne Allen
> > .
> > Follow us at https://www.twitter.com/insulinpumpers
> > Make a long URL short at http://type1.org
> .
> Follow us at https://www.twitter.com/insulinpumpers
> Make a long URL short at http://type1.org
.
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