Research: Treatment The UK service level audit of insulin pump therapy in adults H. D. White 1 , N. Goenka 2 , N. J. Furlong 3 , S. Saunders 4 , G. Morrison 5 , P. Langridge 2 , P. Paul 6 , A. Ghatak 6 and P. J. Weston 5 1 Aintree University Hospital NHS Trust, Liverpool, 2 Countess of Chester NHS Trust, Chester, 3 St Helens and Knowsley NHS Trust, St Helens, 4 Warrington and Halton Hospitals NHS Trust, Warrington, 5 The Royal Liverpool and Broadgreen University Hospitals NHS Trust and 6 Alder Hey Children’s NHS Trust, Liverpool, UK Accepted 19 September 2013 Abstract Aims 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 UK-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 UK 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 UK, 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 UK falls well below the expectation of NICE (15–20%) and that of other European countries (> 15%) and the USA (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users. Diabet. Med. 31, 412–418 (2014) Introduction Continuous subcutaneous insulin infusion therapy has been available for use in clinical practice for > 25 years [1]. However, it is only since the publication of technology appraisal of insulin pump therapy (TA57) by the National Institute for Health and Clinical Excellence (NICE) in 2003 (later updated by TA151 in 2008) that its use in the UK has become more widespread. NICE recommendations for initiating continuous subcu- taneous insulin infusion therapy in adults with Type 1 diabetes mellitus fall into two categories [2]: (1) patient-specific recommendations [HbA 1c > 69 mmol/mol (8.5%) or recurrent hypoglycaemia despite optimized multi-dose injections] and (2) service provider-specific rec- ommendations that include initiation of therapy by a trained specialist team (including consultant diabetologist, diabetes specialist nurse and dietician) and the provision by this team of structured education programmes appropriate for people using insulin pump therapy. Although continuous subcutaneous insulin infusion ther- apy has been shown to have benefit on glycaemic control and hypoglycaemia in people with Type 1 diabetes when compared with multi-dose injections [3,4], it was estimated in 2010 by the York and Humber Public Health Observa- tory that only 2% of adults with Type 1 diabetes in England utilized insulin pump therapy [5]. There were significant limitations of the data published by York and Humber Public Health Observatory as only approximately 50% of units offering pump therapy in England partici- Correspondence to: Helen D. White. E-mail: helen.white@aintree.nhs.uk 412 ª 2013 The Authors. Diabetic Medicine ª 2013 Diabetes UK DIABETICMedicine DOI: 10.1111/dme.12325