Protocol for outpatient screening and initiation of continuous subcutaneous insulin infusion therapy: impact on cost and quality.
The purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 1/2 years.



One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2 1/2 years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin A1C (A1C) were measured and compared.



The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). A1C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections.



A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2 1/2 years.
Sanfield
Jeffrey A
JA
St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
Hegstad
Marcia
M
St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
Hanna
Raouf S
RS
Eastern Michigan University, Ypsilanti, Michigan
D000203:Activities of Daily Living; D000553:Ambulatory Care / Q000458:organization & administration* / Q000523:psychology; D002985:Clinical Protocols / Q000592:standards; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007260:Infusion Pumps; D007328:Insulin / Q000008:administration & dosage*; D008019:Life Style; D008403:Mass Screening / Q000458:organization & administration*; D009730:Nursing Assessment / Q000379:methods / Q000592:standards; D018579:Patient Selection; D011788:Quality of Life; D011795:Surveys and Questionnaires / Q000592:standards
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin