Access to Education and Insulin Pumps for Adults

Diabetes Ireland has launched its 2022 Pre-budget submission and is proposing 8 immediate actions for implementation which will improve the quality of life for over 225,000 people living with diabetes and reduce the long term costs of preventable diabetes complications. The submission is focused on a range of deliverable actions that are person-centred, cost effective and builds on existing HSE commitments to tackle chronic conditions including diabetes.

One of these Actions is Access to Education and Insulin Pumps for Adults

Structured Education and Insulin Pumps for Adults

Structured Education and Insulin Pumps for Adults with Type 1 Diabetes

Over half of adults living with type 1 diabetes do not have access to DAFNE diabetes structured education, a vital training in enabling self-management of insulin dependent diabetes and one third of adults with type 1 diabetes do not have access to insulin pumps as a treatment option (NCG No17, 2018). Diabetes Ireland is calling on government to ensure that funding to complete the current rollout of DAFNE Structured education centres continues in 2022. In additional to this, we are also recommending that one diabetes insulin pump nurse specialist be recruited for each of the DAFNE centres, where this position does not currently exist, to initiate insulin pump therapy for adults with type 1 diabetes.

DAFNE Diabetes structured education

DAFNE Diabetes structured education is the cornerstone of diabetes management for adults with type 1 diabetes. The National Clinical Guidelines for Adults with Type 1 diabetes (2018) states that the clinical evidence DAFNE training provides results in a reduction in hospital admissions, “fewer long-term complications as a result of improved glycaemic control, reduced number of episodes of diabetic ketoacidosis (DKA) resulting in hospital admission, improved psychological adjustment to living with diabetes, improved undertaking of diabetes self-management behaviours, improved clinical outcomes”.

The National Clinical Guidelines for Adults with Type 1 diabetes also highlights that over half (55%) of the adult type 1 diabetes population do not have access to diabetes services providing access to these specialised type 1 diabetes clinics. In 2018, there were 7 accredited DAFNE centres in Ireland with a plan for 11 additional centres in line with implementing the National Clinical Guidelines (NCG) for Adults with type 1 diabetes. So far in 2021, 5 of those additional centres have been established bringing the total to 12. We want to ensure that the remaining 6 centres become DAFNE licensed in 2022. This is 6 WTE at a cost of €0.3M.

Insulin Pumps for Adults

In addition to establishing DAFNE licensed centres, Diabetes Ireland is asking for one diabetes insulin pump nurse specialist for each of the 18 centres where this position is currently not in place to initiate insulin pump therapy for adults with type 1 diabetes.

An insulin pump offers greater flexibility to people with diabetes because the user can administer insulin more precisely than if on injection pens. Uptake of insulin pump therapy is less than 7% in adults with type 1 diabetes comparted to the internationally average which ranges from 15–20% in 2010. The NCG for Adults with Type 1 diabetes states that the percentage of diabetes services providing insulin pumps to adults with type 1 diabetes is 39%, meaning that over two thirds the population does not have access to this treatment option. One of the barriers identified to access was the lack of pump specialist nursing staff (Gajewska, 2020a). Diabetes Ireland is asking for funding to secure a minimum of one WTE diabetes specialist pump nurse in all the 18 DAFNE certified diabetes centres where currently there are none to ensure equal access nationally. This is 18 WTE at a cost of €0.9M.

Insulin pump therapy should be considered as a treatment option when health outcome targets are not being reached on injections or when the individual is extremely sensitive to insulin and requires very small doses and based on additional clinical need.

The clinical evidence on the benefits of insulin pump therapy is vast and have demonstrated improved glucose control, reduces glucose variability, reduction in hypoglycemia events and significant improvement in quality of life (ABCD DTN-UK 2018 and Berget et al. 2019).

With the advances in the development of sensor augmented closed loop “smart” insulin pumps these barriers to pump access present in significant problem for the health service in catching up to current international best practice in diabetes management.

Diabetes Ireland is calling on the government to ensure that funding to complete the implementation of DAFNE Structured education centres in 2022 is in place and also recommending that one diabetes insulin pump nurse specialist be recruited for each of the DAFNE centres, where this position does not exist, to enable the provision of insulin pump therapy as a treatment option for adults with type 1 diabetes.

Diabetes Ireland contacted all TDs and Senators on Wednesday 14 July on behalf of our community asking them to make representations on this and the other issues contained in our Pre-budget submission. Some of our active volunteers’ groups also followed up locally with their own local representatives. We are now asking you to Act. We need your help to highlight this issue once again in advance of the upcoming budget.

Call for Action: What Can I do?

Copy the template below into an email and if you wish add your personal story and reasons why this problem matters to you.
Find your local TD’s (constituency) https://www.oireachtas.ie/
Send your email to your local politicians.

Email/Letter Template

Dear (INSERT NAME OF TD)

I am a constituent and regular voter in your area.

I/my family member have/has lived with Type 1 diabetes for [INSERT YOUR DIABETES DURATION] years, and for years I/he/she have/has been injecting insulin. The problem that I would highlight to you is the lack of access to diabetes education, and therefore to insulin pump therapy in [INSERT YOUR AREA OR DIABETES TEAM]. [INSERT WHY THIS ISSUE MATTERS TO YOU]. (You can write here your personal story and the reason why you would like to highlight this particular issue to politicians).

Access to diabetes education is key to managing diabetes effectively and DAFNE (Dose Adjustment For Normal Eating) structured education is the cornerstone of diabetes management for adults with type 1 diabetes. The National Clinical Guidelines for Adults with Type 1 diabetes (2018) states that the clinical evidence DAFNE training provides results in a reduction in hospital admissions, “fewer long-term complications as a result of improved glycaemic control, reduced number of episodes of diabetic ketoacidosis (DKA) resulting in hospital admission, improved psychological adjustment to living with diabetes, improved undertaking of diabetes self-management behaviours, improved clinical outcomes”. Unfortunately, over half (55%) of people with type 1 diabetes do not have access to diabetes services providing access to clinics specialised in DAFNE and type 1 diabetes, including my clinic in [INSERT YOUR DIABETES TEAM HOSPITAL].

The fact that there is no diabetes education in my area means that I, and others like me, have no access to insulin pump therapy either. An insulin pump gives continuous access to insulin, and opportunity to deliver insulin just by clicking buttons – it improves diabetes management, flexibility and quality of life. Although it is reimbursed, the uptake of pumps is very low in Ireland (7% in adults and 35% in children in 2016) when compared to other countries.

One of the reasons why it is so difficult for some to get an insulin pump, is the lack of trained staff (in particular a pump nurse) in many diabetes centres and therefore the lack of access to diabetes education. In some clinics, the main criteria to get insulin pump prescribed is completion of the DAFNE (Dose Adjustment for Normal Eating) structured education, whereas the waiting lists are very long (even a couple of years), and more than half of people living with type 1 diabetes in Ireland have no access to this course, as it is delivered only in 12 diabetes centres (unfortunately, not in mine).

As education is the key to access insulin pump therapy, and as it is a very close topic to me and my fellow type 1 diabetes peers, I am writing to you to ask for your support by asking the Minister for Health to provide funding for the provision of a WTE diabetes specialist pump nurse in all DAFNE certified diabetes centre to improve access to and availability of insulin pumps.

Parliamentary Questions to ask the Minister for Health:

To ask the Minister for Health if he will provide the funding in the upcoming budget to provide a minimum of one WTE diabetes specialist pump nurse in all 18 DAFNE certified diabetes centres and if he will make a statement on the matter.
To ask the Minister for Health to ensure the provision of one WTE diabetes specialist pump nurse in [INSERT YOUR HOSPITAL], so people with diabetes in my region have greater chances to access insulin pump therapy.
To ask the Minister for Health will the extra funding required to provide the appropriate diabetes staffing resources to provide access to the Dose Adjusting for Normal Eating (DAFNE) programme for all people with Type 1 diabetes be made available in the upcoming budget and if he will make a statement on the matter.

To ask for provision of DAFNE structured education programme for adults with Type 1 diabetes in [INSERT YOUR HOSPITAL/REGION] as recommend in the national clinical guidelines 2018.

For more detailed information about this issue, please see here: https://www.diabetes.ie/advocacy-call-to-action/access-to-education-and-insulin-pumps-for-adults/

Thank you for your time in considering my request.

I hope to hear from you in due course.

Yours sincerely,

Your Name, Address, Email