21_MinimumStandards

D i a b e t e s T r e a t m e n t a l g o r i t h m s
Minimum Standards for the Initiation, Evaluation

and Management of Insulin Pump Therapy Approved 4/26/2012
Introduction
The delivery of insulin through subcutaneous insulin infusion is a therapeutic option for patients
with type 1 diabetes and selected patients with type 2 diabetes. The application of this technology
has been shown to facilitate attaining glucose targets while decreasing hypoglycemia. Successful
pump therapy requires careful training and monitoring of the patient by an experienced insulin
pump management team.
Initiation of therapy
• Insulin pump therapy should only be ordered by a physician and managed by a team who is
experienced in adjusting multi-dose insulin regimens and insulin pumps. The team should
include a physician, diabetes educators, dietitians and other healthcare professionals who are
experienced in insulin pump therapy.
• Physicians should have experience in initiation and management of insulin pump therapy. This
should include structured training in insulin pump therapy (e.g., fellowship training, Endocrine
University® course, continuing education programs) and mentored management of patients
already established on pump therapy.
Evaluation of the patient prior to initiation of therapy

Appropriate patient selection is essential as not all patients are good candidates for insulin pump
therapy. Evaluation of the potential pump patient or his/her support system should include
assessment of:
• ability to manage a pump program
• ability and willingness to frequently check his/her glucose, whether with fingerstick glucose
monitoring alone and/or combined with a continuous glucose sensor
• ability to count carbohydrates
• ability to adjust insulin doses based on carbohydrate content of meal
• ability to identify changes in insulin needs due to changes in physical activity and food intake
• ability to recognize, troubleshoot and manage hyperglycemia and hypoglycemia
Standards for management after initiating insulin pump therapy
• The team must have a member that is experienced in managing and troubleshooting insulin
pump therapy on call 24 hours a day
• The team must be able to assess the patient frequently during the first six weeks of insulin
pump therapy
• The team must reassess the patient or his/her support system for continued appropriateness
for insulin pump therapy as outlined above
1 of 2– Minimum Standards for the Initiation, Evaluation and Management of Insulin Pump Therapy See disclaimer at www.tdctoolkit.org/algorithms_and_guidelines.asp
D i a b e t e s T r e a t m e n t a l g o r i t h m s
• The team must evaluate the patient’s ability to use the device at least every three months.
Skills to be assessed include the patient or his/her support system demonstrating:
• ability to navigate the pump to view current settings
• ability to make changes in his/her preset program in response to changes in daily
routine and physical activity
• ability to troubleshoot unexpected blood sugars
• ability to use basal/bolus therapy as an alternative if needed
REFERENCES
• Colquitt JL, Green C, Sidhu MK, Hartwell D, Waugh N. Clinical and cost-effectiveness of continuous subcutaneous insulin infusion
for diabetes. Health Technol Assess 2004 Oct;8(43):iii, 1-171.
• Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin
injections in patients with type 1 diabetes: meta-analysis of randomized controlled trials. BMJ 2002;324(7339):705-10.
• Raskin P, Bode BW, Marks JB, et al. Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally
effective in type 2 diabetes: a randomized, parallel-group, 24-week study. Diabetes Care 2003;26(9):2598-603.
• Retnakaran R, Hochman J, Devries JH, et al. Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of
baseline A1c. Diabetes Care 2004;27:2590-96.
2 of 2– Minimum Standards for the Initiation, Evaluation and Management of Insulin Pump Therapy See disclaimer at www.tdctoolkit.org/algorithms_and_guidelines.asp

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D i a b e t e s T r e a t m e n t a l g o r i t h m s

Minimum Standards for the Initiation, Evaluation

Evaluation of the patient prior to initiation of therapy

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