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[IPk] BDA statement on insulin pump therapy

I recently received the following statement from the chief executive of the
British Diabetic Association on insulin pump therapy. It was approved by
the board of trustees at their April 2000 meeting. This is only a
beginning, but it certainly represents a big step forward. It was I believe
prompted in part by the letters that members of this list sent to the BDA.


Statement follows:

Current Position on Pump Therapy

The British Diabetic Association is aware that insulin pump therapy is a
treatment which some people with Type 1 diabetes find beneficial in terms of
overall control and quality of life. Certain people experience difficulties
in controlling their diabetes and pumps may provide an alternative
management option to multiple injections. Such people with diabetes should
have equal access to the best diabetes care and health outcomes available.
The BDA believes that for certain people it should be available according to
need and not ability to pay. As a first step towards progressing this issue
we have written to the Department of Health asking them to clarify their
position on pump therapy use across the UK. The BDA calls for further
research into the effectiveness of pump therapy.

Currently approximately 0.1% of people with Type 1 diabetes in the UK use
pumps, compared with about 5% in the United States, Sweden, Norway, Germany
and the Netherlands. Pump therapy is not a new treatment for Type 1
diabetes, having been introduced in the 1980's. At this time, the UK's
experience was largely negative, and has led to concerns about usage.
However, the new generation of pumps are being used and promoted more widely
in Europe and the rest of the world as an alternative treatment method. This
would suggest that many of the safety fears have been addressed.

Advice to people with diabetes

Pump therapy is not suitable for all people with Type 1 diabetes. From
discussions with health care professionals, pump users and pump
manufacturers, people most suited to using pumps must:

   * Have a good knowledge and understanding of diabetes
   * Be well motivated and willing to take control of their diabetes
   * Be prepared to test blood glucose levels at least four times a day and
be confident in acting on those results
   * Have awareness of how insulin, exercise and food intake affect blood
glucose levels

Children should only be considered for pump therapy if they are under the
care of a paediatric diabetes team with extensive knowledge of the therapy.

If people with diabetes wish to consider pump therapy they should initially
discuss this with their health professional. It is important to bear in mind
that their own diabetes team may not be familiar or confident in commencing
pump therapy, and may need to seek advice. If you feel you meet the
suitability criteria and wish to consider pump therapy, but your health
professional is unsure, the BDA recommends that in the first instance you
discuss this issue with your GP. In some instances it may be appropriate to
see if your GP can arrange for a second opinion to be provided.

We are aware that a major concern for health care professionals is the lack
of experience of pump use in the UK. To overcome this problem, the BDA would
like to see the establishment of a network of health professionals with
experience in pump use, who could advise colleagues less experienced in pump

The BDA continues to seek expert advice and will continue to consider our

April 2000

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