Authors' objectives:

The goal of this report is to evaluate the efficacy of insulin infusion pumps considering the scientific evidence available. This report takes into account, not only the results on the efficacy of these pumps compared to other insulin delivery methods, but also the patients best suited to use the pumps and the effect on their quality of life.

Authors' recommendations: The good results on metabolic control with intensive insulin therapy, which are the same whether the insulin therapy is administered through multiple injections or infusion pumps, tend to be associated with a greater frequency of daily glycemic self-control more than with the insulin administration procedure itself. The literature offers information on both external pumps and implantable pumps. However, although the expectations of the latter ones are promising, many uncertainties remain unresolved, such as the importance of portal administration or the stability of the insulin used. In any case, although both types of pumps are marked CE, the only ones on our market are the external ones. The use of subcutaneous external infusion pumps for insulin administration is associated with a strict selection of patients who have shown sufficient ability and discipline to follow through with this mode of administration. In general terms, the patient profile for those undergoing this method of administration is the same as those undergoing intensive insulin therapy, with no specific factors affecting the choice of MI or CSII. However, some authors suggest using pumps during pregnancy or in those patients who have not been able to achieve a good metabolic control using multiple injections. There are few studies evaluating the impact of the use of insulin infusion pumps on the patients quality of life, and the results are inconclusive. The scales used contain various domains, and only in some of them, which generally have to do with the patients satisfaction with the treatment, does there seem to be an advantage in this mode of treatment. The use of insulin infusion pumps appears to be related more to a preference on the part of the patient than a therapeutic necessity or an absolute improvement in his or her quality of life. Therefore, the user needs to be willing to make a significant contribution on his part if a decision on public coverage is to be made. Since the application of this technology requires a permanent assistance system, if the National Health System were to provide some sort of coverage, organizational measures would have to be implemented, such as the adaptation of a special service which would be able to care for a large enough number of patients and be capable of maintaining a national normalized register.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.isciii.es/aets

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion de Tecnologias Sanitarias (AETS)