Insulin pumps
The Ministry of Health’s (2003) Service Specification provides, in no specific order, the following clinical priority access criteria for insulin pumps.
Patients with type 1 diabetes:
with hypoglycaemic unawareness and autonomic neuropathy suffering recurrent severe hypoglycaemic episodes
with poor glycaemic control and unacceptable fasting blood glucose levels due to a marked dawn phenomenon especially in adolescents
with poor glycaemic control despite multiple daily injections (MDI) who are proven to have improved control with a trial of insulin pump therapy and recurrent diabetic keto-acidosis despite all efforts to avoid it
with eating disorders (in highly selected cases)
and other chronic illness, eg, coeliac disease
variable or prolonged insulin action.
Additional criteria state that patients, caregivers or parents must:
have the patient on optimal conventional therapy
monitor and record blood glucose a minimum of four times per day, and make appropriate adjustments
be responsible and psychologically stable
be willing to quantitate food intake, especially carbohydrate in the diet
be willing to comply with medical/nursing follow-up
be able to cope with and manage the technical challenges of the equipment
have committed parental/caregiver supervision in diabetes care.
Continuous glucose monitoring systems
A clinical practice guideline for the use of continuous glucose monitoring was developed by the US Endocrine Society, and can be accessed here: www.guideline.gov/content.aspx?id=35254.
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