Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Responding to need: the development of a Continuous Subcutaneous Insulin Infusion (CSII) Clinical Practice Guide, Patient/Carer Consent and Inpatient Rate Record. (#385)

Collette Hooper 1 , Pauline Hill 2 , Barbie Sawyer 3 , Jane Giles 1
  1. Country Health SA, Country Health South Australia, Adelaide, SA, Australia
  2. School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Services, Flinders University, Adelaide, SA, Australia
  3. South East Regional Community Health Service, Mount Gambier Hospital and Health Service, Mount Gambier, SA, Australia

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researchers, organisations, pharmaceutical and manufacturing companies were contacted to identify additional published, unpublished, ongoing trials and grey literature.11,12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.

  1. Australian Institute of Health and Welfare 2012. Insulin pump use in Australia. Diabetes Series no.18. cat. no. CVD 58. Canberra, Australian Institute of Health and Welfare.
  2. American Diabetes Association 2015. Classification and diagnosis of diabetes. Section 2. In Standards of Medical Care in Diabetes. Diabetes Care vol. 38(1), pp. 8–16.
  3. Australian Diabetes Society 2012, Position Statement: Guidelines for Routine Glucose Control in Hospital.
  4. Bailon R.M, Partlow B.J, Miller‐Cage V.M 2009. Continuous subcutaneous insulin infusion (insulin pump) therapy can be safely used in the hospital in select patients. Endocrine Practice, vol. 15, pp. 24‐29.
  5. Houlden R, Moore S 2014. In-Hospital Management of Adults using Insulin Pump Therapy. Canadian Journal of Diabetes, vol. 38, pp. 126-133.
  6. Buchko B, Artz B, Dayhoff S, March K 2012. Improving Care of Patients with Insulin Pumps During Hospitalisation. Journal of Nursing Care Quality, vol. 27 (4), pp. 333-340.
  7. Barnard K.D, Lloyd C.E & Skinner T.C 2007. Systematic literature review: quality of life associated with insulin pump use in Type 1 diabetes. Diabetic Medicine, vol. 24, pp. 607-617Cheung, N and Chipps, D, 2010, Sliding scale insulin: Will the false idol finally fall?, Internal Medicine Journal, 40: p 662-4.
  8. Cook C, Beer K, Seifert K, Boyle M, Mackey P, Castro J 2012. Transitioning Insulin Pump Therapy from the Outpatient to the Inpatient Setting: A Review of 6 Years’ Experience with 253 Cases. Journal of Diabetes Science and Technology, vol. 6(5), pp. 995-1002.
  9. Pańkowska E, Blazik M, Dziechciarz P, Szypowska A, Szajewska H 2009. Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: A systematic review and meta-analysis of randomized control trials. Paediatric Diabetes, vol. 10(1), pp. 52-58.
  10. Siebenhofer A, Plank J, Berghold A, Horvath K, Sawicki P.T, Beck P, Pieber, T.R 2004. Meta-analysis of short-acting insulin analogues in adult patients with type 1 diabetes: Continuous subcutaneous insulin infusion versus injection therapy. Diabetologia, vol. 47(11), pp. 1895-1905.
  11. Cook C, Boyle M, Cisar N, Miller-Cage V, Bourgeois P, Roust L, Smith S, Zimmerman R 2005. Use of continuous subcutaneous insulin infusion (Insulin Pump) therapy in the hospital setting: proposed guidelines and outcome measures. The Diabetes Educator, vol. 31, pp. 849-857.
  12. Statewide Diabetes Clinical Network Steering Committee 2012. Inpatient Guidelines: Insulin Infusion Pump Management. Clinical Access and Redesign Unit, Queensland Health.