This document was published more than 2 years ago. The nature of the evidence may have changed.
Good control of the blood glucose level is vital to avoid diabetes complications. In type 1 diabetes and sometimes in type 2 diabetes, intensive insulin therapy is required, which involves multiple daily injections. The most common complication associated with this therapy is low blood glucose (hypoglycaemia), which can have serious consequences. An alternative to injections for intensive insulin therapy is continuous insulin delivery using a pump, also known as continuous subcutaneous insulin infusion (CSII).
Surrogate measures (such as HbA1c, C-peptide and glucose variability) are not evidence-graded, but are described in the report. In addition, HbA1c is reported in Appendix 3.
There are no comprehensive statistics on the use of insulin pumps either alone or in combination with continuous subcutaneous glucose monitoring (SAP) in Sweden. In order to chart practice of the use of these methods in specialist care more closely, a major study of practice was conducted that involved all the diabetes clinics in Sweden.
Insulin pump therapy costs SEK 11 000 more per patient and year than intensive injection therapy. Since approximately 10 000 patients are treated with insulin pumps in Sweden today, it would currently amount to an additional cost of about SEK 110 million per year. If insulin pump therapy is combined with continuous glucose monitoring (SAP), the annual additional cost increases by around another SEK 28 000 per patient.
In order to calculate whether insulin pump therapy and SAP are cost-effective methods compared to injection therapy and self-monitoring of blood glucose with test strips, the increased treatment costs need to be considered in relation to the long-term effects on health.
Diabetes is a disease that requires considerable patient effort both day and night in a very different way from most other illnesses. Other values than the medical effects must therefore be taken into account. The methods of administrating insulin and monitoring blood glucose have considerable impact on the individual patients and their families.
How to cite this report: SBU. Insulin pumps for diabetes. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2013. SBU report no 2013-03 (in Swedish).
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