Comparison of the insulin pump and multiple daily insulin injections in intensive therapy for type 1 diabetes

For several years now, continuous subcutaneous insulin infusion, or the insulin pump, has been an alternative to multiple daily insulin injections in intensive therapy for type I diabetes. Pump therapy, which is not covered by the public plan in Québec, avoids repeated injections and offers greater flexibility in adjusting the insulin dose on the basis of the level of physical activity and food intake.

This report examines the safety and efficacy of this technology and the economic aspects of introducing it into Québec’s health-care system, and presents the patient and health professional perspectives in the Québec context.

An evaluation of the evidence indicates that this technology is safe for motivated patients who are adequately trained and supported by a specialized team and that the improvement in glycemic control offered by the pump, though very modest for the general population of diabetic patients, could be significant for a specific subgroup of patients. Although the cost-effectiveness data for the insulin pump are limited, they do seem to indicate that its use is efficient when it is prescribed to selected patients.

In light of this analysis, AETMIS recommends, among others: 1) that a clear, consistent policy be developed for the use of the insulin pump as a treatment modality for a limited, selected group of patients with type 1 diabetes, with specific prescription and coverage modalities; and 2) that a multidisciplinary task force be formed and specifically charged with defining insulin pump use (patient selection, prescription and follow-up criteria and tools) and procedures for implementing an insulin pump access program (designated centres, care teams, evaluation) in the current Québec context.