Insulin pumps: are services and health equity undermining technological progression?

Curtis, L. R.; Alington, K.; Partridge, H. L.

The inspiring story of insulin pump development contains numerous hurdles overcome with leaps in technology. Miniaturisation and increased reliability have led to a discrete device that can deliver insulin in a more physiologic profile than multiple daily injections. Accumulating evidence supports not only glycaemic benefits with lower HbA1c, reduced glucose variability and reduced hypoglycaemia rates but also improved quality of life and an association with reduction in mortality. Understandably, patient groups list access to technologies as a key priority for living well with diabetes. Despite this, uptake of insulin pumps remains below forecast with variation geographically and between socioeconomic groups. Criteria from the National Institute for Health and Care Excellence aim to standardise local commissioning;however, a major barrier to initiating pump services is sufficient staff numbers with appropriate training and experience. To aid growth, services could be better supported to access training and given flexibility in deploying their resources. Collaboration between centres with increasing use of the virtual platform for education and clinical support may address the equity of delivery. There has been proliferation of available devices with differing advantages and limitations;for example compatibility with software and discretion. Sensor augmentation has enabled a degree of automated insulin delivery with predicted hypoglycaemia avoidance;however, accessibility is restricted and some highly motivated people with type 1 diabetes have set up their own semi-automated insulin delivery systems using open source code. Copyright © 2021 John Wiley & Sons.