title: The U.K. service level audit of insulin pump therapy in adults.
abstract: OBJECTIVE
  The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first U.K.-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here.
  
  
  METHODS
  All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the U.K. were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool.
  
  
  RESULTS
  One hundred and eighty-three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the U.K., of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety-three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0-8), mean whole-time equivalent diabetes specialist nurses was 0.62 (range 0-3) and mean whole-time equivalent dietitian services was 0.3 (range 0-2), of which 39, 61 and 60%, respectively, were not formally funded.
  
  
  CONCLUSIONS
  The prevalence of continuous subcutaneous insulin infusion use in the U.K. falls well below the expectation of NICE (15-20%) and that of other European countries (> 15%) and the U.S.A. (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users.
authors.affiliation: Aintree University Hospital NHS Trust, Liverpool, UK.
authors.forename: H D
authors.initials: HD
authors.lastname: White
authors.forename: N
authors.initials: N
authors.lastname: Goenka
authors.forename: N J
authors.initials: NJ
authors.lastname: Furlong
authors.forename: S
authors.initials: S
authors.lastname: Saunders
authors.forename: G
authors.initials: G
authors.lastname: Morrison
authors.forename: P
authors.initials: P
authors.lastname: Langridge
authors.forename: P
authors.initials: P
authors.lastname: Paul
authors.forename: A
authors.initials: A
authors.lastname: Ghatak
authors.forename: P J
authors.initials: PJ
authors.lastname: Weston
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable / Q000706:statistics & numerical data; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin