Background: Continuous Subcutaneous Insulin Infusion (CSII) is used in the management of growing numbers of patients with type 1 diabetes (T1D) in Australia.1 Anecdotal reports suggest that patients with T1D established on CSII usually prefer to continue CSII use during hospital admissions.2,3 Observational reports indicate that patients with T1D admitted to hospital who continue on CSII fare at least as well as those transferred to subcutaneous insulin injections and managed by the diabetes team.4,5
Aim: To provide a CSII clinical practice guideline, patient/carer consent and inpatient rate record to guide generalist staff so that people with T1D being treated in the outpatient setting with a CSII, can continue to be managed safely with CSII whilst admitted in an Country Health SA (CHSA) hospital.
Method: A literature search was conducted to capture articles published from 2009-2014 referencing ‘smart pump’ technology. An online search was conducted to identify studies, position statements and clinical guidelines relevant. All reference lists and bibliographies retrieved were searched for additional studies.6,7,8,9,10 Related diabetes centres, researchers, organisations, pharmaceutical and manufacturing companies were contacted to identify additional published, unpublished, ongoing trials and grey literature.11,12
Results: The literature search did not identify any relevant systematic reviews or randomised control trials of inpatient CSII use. However, based upon expert international consensus opinion, the recommendation of continued CSII use in the person with T1D in the inpatient setting, subject to conditions, is supported. The collated findings assisted discussion within CHSA Diabetes Service team and the subsequent development of a CSII Clinical Practice Guideline, Consent Form and Inpatient Rate Record.
Conclusion: The literature search and lessons learnt underpinned the development of CSII resources for use in CHSA rural and remote hospitals. Given that there is limited evidence, further research into the use of CSII in the inpatient setting based on these resources is planned.