HNY Policy and Pathway Repository - East Riding

Children and adults with Type 1 and Type 2 Diabetes mellitus

This intervention is commissioned for people with:

• Type 1 Diabetes mellitus, who meet the NICE criteria for insulin pump therapy* AND
  • multiple daily injections are impractical/inappropriate, so an injection port is being used as an alternative to insulin pump therapy OR
  • are avoiding/missing insulin injections due to significant anxiety/needle phobia OR
  • HbA1c is >69 mmol/l is related to poor compliance with treatment OR
  • are injecting into lipo-hypertrophied areas despite support and advice to avoid these areas.

AND

• Type 2 Diabetes mellitus, if recommended by a Diabetes specialist AND
  • on >1 injection of insulin a day OR
  • multiple daily injections are impractical/inappropriate, so an injection port is being used as an alternative to insulin pump therapy OR
  • are avoiding/missing insulin injections due to significant anxiety/needle phobia OR
  • HbA1c is >69 mmol/l is related to poor compliance with treatment OR
  • are injecting into lipo-hypertrophied areas despite support and advice to avoid these areas.

*NICE criteria for insulin pump therapy:

• adults and children 12 years and older with Type 1 Diabetes mellitus AND
• attempts to achieve target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia (repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life) OR
• HbA1c levels have remained high (69 mmol/l or above) on multiple daily injection (MDI) therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care

ALSO

Children younger than 12 years with Type 1 Diabetes for whom MDI therapy is impractical/inappropriate. (NB these children should have a trial of MDI therapy between 12 and 18 years.)

Clinical evidence for the use of i-Port Advance® device is limited and there is currently no NICE guidance or appraisal of it. However, based on problems associated with insulin administration by injection(s), such as pain, anxiety (needle phobia), lipo-hypertrophy, and risk of infection, in those who find the device more acceptable it may assist in achieving optimal glycaemic control reducing admissions from diabetic ketoacidosis (DKA) and reducing the insulin doses required.

 

Use of the i-Port Advance® device in selected patients with Type 1 Diabetes mellitus may also offer a cost saving in delaying the progression to insulin pump therapy. In selected patients with Type 2 diabetes mellitus, use of the device may offer a cost saving in terms of improved glycaemic control and reduction in micro-vascular complications and addition drug therapies e.g. retinopathy and laser, painful neuropathy requiring other oral agents (duloxetine/gabapentin).

NTAG-Decision-Summary-i-Port-Advance®-for-use-in-children-and-adults-with-diabetes-June-2022-final-for-web.pdf