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Availability of and access to continuous subcutaneous insulin infusion therapy for adults with type 1 diabetes in Ireland

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Abstract

Aims

The uptake of continuous subcutaneous insulin infusion (CSII) is low in adults with type 1 diabetes mellitus (T1DM) in Ireland, compared to other countries where CSII is reimbursed. To explore the reasons for the low uptake, this study aims to investigate the availability of CSII in adult diabetes clinics in Ireland.

Methods

A national survey of all adult diabetes clinics (public and private) in Ireland was conducted and completed anonymously by the lead physician/diabetes nurse specialist in each clinic. Descriptive statistics and comparisons between clinics offering different levels of care for CSII are presented.

Results

Of 50 diabetes clinics invited, 47 (94%) participated in the study. Fifteen clinics (32%) offered no support for CSII, while 21 (45%) reported offering both training to commence CSII and ongoing support. Based on the survey findings, access to CSII was unavailable for 2426 (11%) of those with T1DM. The majority (n = 15,831, 71% of 22,321 T1DM population) received diabetes care from clinics offering CSII training, but only 2165 were using CSII (10% of T1DM population). Uptake of CSII was higher in clinics offering training than in those offering follow-up care for CSII only (12% vs. 5%, p < 0.001). Clinics offering all CSII services had more specialists (p = 0.005 for endocrinologists and p < 0.001 for dietitians). Reasons for not offering CSII services included staff shortages and heavy workload.

Conclusions

This study highlights the low uptake of CSII in Ireland and demonstrates that, even when reimbursed, other barriers to uptake of CSII can limit its use.

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Acknowledgements

We would like to thank Diabetes Ireland for their support in the survey preparation and data collection and all participants who completed the survey for the study.

Funding

This research was funded by the Health Research Board (HRB) SPHeRE/2013/1 as a part of the PhD programme, and KG is a HRB SPHeRE Programme scholar. KB is funded by a Health Research Board Award (RL-15-1579).

Author information

Authors and Affiliations

  1. Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland

    Katarzyna Anna Gajewska & Kathleen Bennett

  2. Global Health Unit, Department of Health Sciences, University Medical Centre, Groningen, The Netherlands

    Regien Biesma

  3. 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland

    Seamus Sreenan

  4. Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland

    Seamus Sreenan

Authors
  1. Katarzyna Anna Gajewska
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  2. Regien Biesma
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  3. Kathleen Bennett
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  4. Seamus Sreenan
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Corresponding author

Correspondence to Katarzyna Anna Gajewska.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of the Royal College of Surgeons in Ireland (RCSI) (Ethics reference no: 1445) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants at the time of completing the survey.

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Appendix S1

STROBE Statement—checklist of items that should be included in reports of observational studies. (PDF 99 kb)

Appendix S2

Accessing insulin pump therapy and service by adults with Type 1 diabetes in Ireland. The National Survey—Finalized version 12/10/2017. (PDF 2016 kb)

Appendix S3

Reasons given for deciding whether to commence a person with diabetes on CSII therapy or not. (PDF 41 kb)

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Gajewska, K.A., Biesma, R., Bennett, K. et al. Availability of and access to continuous subcutaneous insulin infusion therapy for adults with type 1 diabetes in Ireland. Acta Diabetol 57, 875–882 (2020). https://doi.org/10.1007/s00592-020-01497-6

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