SRP 066 Insulin Pump Therapy- continuous subcutaneous insulin infusion

Policy Number: SRP 066
Policy Name: Insulin Pump Therapy- continuous subcutaneous insulin infusion
Status: Individual Prior Approval
Effective Date: 1 October 2024
Next Review Date: 1 October 2026

MSE ICB commissions the use of continuous subcutaneous insulin infusion (CSII in line with National Institute for Health and Care Excellence (NICE) Technology Appraisal (TA) 151

A separate policy covers the commissioning of Hybrid closed loop systems (HCL) for managing blood glucose levels in type 1 diabetes in line with National Institute for Health and Care Excellence (NICE) Technology Appraisal (TA) 943.

MSE ICB commissions the use of standalone continuous subcutaneous insulin infusion (CSII) or ‘insulin pump’ therapy as a treatment for adults and children 12 years and over with type 1 diabetes mellitus where:

attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections result in the person having ‘disabling hypoglycaemia’, OR
HbA1c levels have remained high at 69mmol/mol (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 AND
The person has attended and completed a ICB approved diabetes educational course for example DAFNE.

CSII therapy is commissioned as a treatment option for children younger than 12 years with type 1 diabetes mellitus provided that:

Multiple Daily Injection (MDI) therapy is considered to be impractical or inappropriate, and
Children on insulin pumps would be expected to undergo a trial of therapy between the ages of 12 and 18 years.

Insulin pump therapy should only be started by a trained specialist team. This team should include a doctor who specialises in insulin pump therapy, a diabetes nurse and a dietitian (someone who can give specialist advice on diet). This team should provide structured education programmes and advice on diet, lifestyle and exercise that is suitable for people using insulin pumps.

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 and notified to the commissioner. Patients must be reviewed against these targets at least annually. Continuation of funding will be dependent upon demonstrating sustained improvement and management in glycaemic control as above.

Insulin pump therapy is not routinely funded for people with type 2 diabetes mellitus.

In accordance with NICE principles MSE ICB support funding of the insulin pump with the lowest acquisition cost that meets the clinical needs of the patient.

Funding for patients not meeting the above criteria will only be made available in clinically exceptional circumstances.

Individual funding requests should only be made where the patient demonstrates clinical exceptionality.

Find out more information on applying for funding in exceptional clinical circumstances.