New recommendations on insulin pump use

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology offered guidance on optimal and safe use of insulin pumps in a recent consensus statement.

The document, published in the May Endocrine Practice, updates a consensus statement issued by AACE in 2010. The new statement adds information about improvements in pump technology, including the first pump with a system to suspend insulin therapy if a low-glucose reading is noted and a disposable insulin delivery system for type 2 diabetes. The statement also reviews data on the use of pumps in specific patient populations, such as children, pregnant women, and type 2 diabetics (including continuous subcutaneous use of concentrated regular U-500 insulin). The statement's section on patient safety issues has also been updated.

The statement offers recommendations on selection of patients for insulin pump use. The ideal candidate for a pump has either type 1 diabetes or intensively managed, insulin-dependent type 2 diabetes; performs 4 or more insulin injections and blood glucose measurements daily; and is motivated, willing, and able to use the technology safely and effectively, including maintaining frequent contact with a health care team.

The statement also discusses use of pumps in hospitals and recommends that if a hospitalized patient is not able to manage his or her own pump, the specialist(s) responsible for ambulatory pump management should be contacted. Hospital patients and physicians should also be encouraged not to discontinue pump infusions and should contact specialists as needed. The April ACP Hospitalist also discusses inpatient management of insulin pumps.

The consensus statement also offers a number of recommendations on education and training of patients who use pumps. Initial and ongoing training should be provided by a multidisciplinary team under the direction of an experienced endocrinologist or diabetologist. The statement also provides data on comparisons of different pumps, safety issues, and cost-effectiveness.