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CSII Therapy in children and young people- where are we going?

CSII Therapy in children and young people- where are we going?. Dr Gillian Lyder New Cross Hospital, Wolverhampton. Service at Wolverhampton. Started in 2000 Initially led by Dr Janet Anderson → Dr Gregory Minnaar Currently 19 patients Team: Doctor, Diabetes Nurse and Dietician

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CSII Therapy in children and young people- where are we going?

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  1. CSII Therapy in children and young people- where are we going? Dr Gillian Lyder New Cross Hospital, Wolverhampton

  2. Service at Wolverhampton • Started in 2000 • Initially led by Dr Janet Anderson → Dr Gregory Minnaar • Currently 19 patients • Team: Doctor, Diabetes Nurse and Dietician • 2 clinics every 3 months

  3. Pump clinic at Wolverhampton

  4. Benefits of CSII • Reduces A1C and incidence of hypoglycaemia in children • Does not increase the incidence of DKA • Offers flexibility, choice and a better quality of life for children and their families

  5. Insulin Pump Therapy Offers Flexibility, Choice and a Better Quality of Life for Children and Their Families Challenges Specific to Children CSII Benefits Of 291 patients (mean duration of CSII 3.7 ± 1.9 years), 92.8% remained on Insulin Pump Therapy Scrimgeour L, et al.. Diabetes Technol Ther. 2007;9:421-428 Wilson V, Paediatric Nursing 2008; 20, 2; 14-18

  6. NICE and insulin pumps • Initial NICE guidelines published in 2003 • Guidelines revised in 2008

  7. CSII for ≥12 years • Attempts to achieve target HbA1c levels with multiple daily injections (MDIs) result in the person experiencing disabling hypoglycaemia • (disabling hypoglycaemia is defined as the 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 (that is, at 8.5% or above) on MDI therapy despite a high level of care.

  8. CSII < 12 years • MDI therapy is considered to be impractical or inappropriate, and • children on insulin pumps would be expected to undergo a trial of MDI therapy between the ages of 12 and 18 years.

  9. NICE guidelines • Estimated that pumps may be clinically indicated for: • 10-50% children < 12 years • 8-15% > 12 years

  10. Implications for diabetes services • How will the services develop to provide best service for patients • Who will be offering an insulin pump service • Training issues

  11. Where do we see the paediatric insulin pump service in the region in 10 years time?

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