A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy Cari Berget, Laurel H

Total Page:16

File Type:pdf, Size:1020Kb

A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy Cari Berget, Laurel H A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy Cari Berget, Laurel H. Messer, and Gregory P. Forlenza ■ IN BRIEF Insulin pump therapy is advancing rapidly. This article summarizes the variety of insulin pump technologies available to date and discusses important clinical considerations for each type of technology. ontinuous subcutaneous in- use an insulin pump (6) instead of a sulin infusion (CSII), more multiple daily injection (MDI) reg- Ccommonly referred to as insu- imen for intensive insulin therapy. lin pump therapy, is one of the most Additionally, the use of insulin pump notable advancements in diabetes therapy for individuals with type 2 technology in the past 50 years. The diabetes is increasing (7,8). first commercial insulin pumps were There are many advantages to on the market as early as the 1970s; using an insulin pump compared however, rapid uptake of insulin to an MDI regimen. Insulin pump pump technology did not occur until therapy allows for more precise and the early 2000s, after the conclusion flexible insulin dosing with fewer of the landmark Diabetes Control and injections. Many individuals with Complications Trial (DCCT) in the type 1 diabetes report using insulin early 1990s. The DCCT demonstrat- pumps because they want improved ed the importance of intensive insu- glycemic control and a more flexible lin therapy to maintain tight glycemic lifestyle than is afforded with MDI control and prevent diabetes compli- therapy, especially around meals and cations such as retinopathy, neuropa- social situations (9). Many studies thy, nephropathy, and cardiovascular and systematic reviews have demon- disease (1–4). strated improved glycemic control Since the conclusion of the DCCT, and a reduction in hypoglycemia insulin pump technology has ad- with insulin pump therapy compared vanced rapidly in an attempt to more to MDI in pediatric and adult popu- closely mimic physiologic insulin lations with type 1 diabetes (10–17). secretion and help patients achieve Although some randomized con- tight glycemic control while mini- trolled trials have shown no difference mizing the risk of hypoglycemia. As in glycemic control in young children University of Colorado, Denver, Barbara a result, use of insulin pumps has (<7 years of age) when comparing Davis Center for Childhood Diabetes, increased dramatically in the United insulin pump therapy to MDI (18,19), Aurora, CO States from <7,000 users in 1990 to parental satisfaction with insulin Corresponding author: Cari Berget, [email protected] nearly 100,000 users in 2000 (3) and pump therapy is high (20). Further, >350,000 users today (5). The major- insulin pumps offer many advantages https://doi.org/10.2337/ds18-0091 ity of insulin pump users have type 1 in managing unpredictable eating ©2019 by the American Diabetes Association. diabetes, although ~10% have type 2 habits and low insulin requirements Readers may use this article as long as the work is diabetes (5). According to the T1D in the youngest children (21), suggest- properly cited, the use is educational and not for profit, and the work is not altered. See www. Exchange registry, >60% of indi- ing that insulin pump therapy may be diabetesjournals.org/content/license for details. viduals within the T1D Exchange an ideal option for many young chil- 194 SPECTRUM.DIABETESJOURNALS.ORG BERGET ET AL . dren with type 1 diabetes and their families. Overall, insulin pump technology is evolving at an extraordinary rate, with new technologies becoming available every year. The integration of insulin pumps with continuous glucose monitoring (CGM) systems has drastically expanded the insulin pump market with “smarter” insu- lin pumps that suspend insulin for hypoglycemia or even automate some insulin delivery, all with the goal of helping individuals meet glycemic PRACTICE FROM RESEARCH TO targets with less burden (22,23). ■ FIGURE 1. Insulin pump with tubing. The tubing connects the insulin pump, However, this rapid technological which contains the reservoir where the insulin is held, to the infusion cannula progression can be overwhelming for inserted in the subcutaneous tissue. individuals with diabetes and their health care providers. Thus, the pur- poses of this article are 1) to provide an overview of insulin pump technol- ogies, from simple, disposable pumps designed for those with type 2 dia- betes to complex automated insulin delivery systems and 2) to discuss the clinical implications of these insulin pump technologies. Conventional Insulin Pump Therapy An insulin pump is a small, digital de- vice that continuously delivers rapid- acting insulin through a small catheter ■ FIGURE 2. Insulin pump without tubing (“patch pump”). Tubeless patch pumps inserted into the subcutaneous tissue contain the insulin reservoir and the infusion cannula and adhere directly to the skin. and secured in place on the skin with A handheld device is used to program insulin delivery and insert the infusion cannula. adhesive (referred to as an “infusion set” or “infusion cannula”). In most reservoir for up to 144 hours, but meals or high blood glucose correc- insulin pumps, the infusion set con- glulisine should be replaced every 48 tion (bolus). Basal insulin delivery nects to the pump by plastic tubing, hours due to a risk of crystallization. replaces the use of the longer-acting and insulin infuses from the pump Regular insulin is also FDA-approved exogenous insulin formulations used through the tubing to the infusion set for use in pumps and is sometimes in MDI regimens. A multitude of cannula and into the subcutaneous used instead of rapid-acting for- factors influence basal insulin needs, tissue (Figure 1). Some pumps, re- mulations because of its lower cost. including physiology, developmental ferred to as “patch pumps,” do not use Concentrated insulins (e.g., U200 or life stage (i.e., puberty or growth), tubing and instead adhere directly to U500), dilute insulin (e.g., U50 or activity level, time of day, and sleep the skin. Patch pumps deliver insulin U10), and ultra-rapid-acting insulin schedule. Insulin pumps deliver basal through the infusion cannula and are analogs (e.g., Fiasp) are undergoing insulin in increments as small as 0.01 programmed from a remote device us- studies but are not yet FDA-approved unit/hour and permit multiple rates ing wireless technology (Figure 2) (24). for use in pumps. of basal infusion throughout the day Insulin pumps generally use rapid- Insulin pumps deliver insulin in and night to best optimize glycemic acting insulin formulations (i.e., insu- two primary ways: a continuous control and individualize therapy, lin lispro, aspart, or glulisine). Lispro infusion of rapid-acting insulin mimicking nondiabetes physiology. and aspart are approved by the U.S. throughout the day and night (basal), Additionally, many insulin pumps Food and Drug Administration and discrete, one-time doses of rap- include a temporary basal feature, (FDA) for use in a pump insulin id-acting insulin given by the user for allowing users to temporarily increase VOLUME 32, NUMBER 3, SUMMER 2019 195 FROM RESEARCH TO PRACTICE / USING DATA TO IMPROVE DIABETES OUTCOMES or decrease basal delivery by a percent- therapy. These studies have reported units of bolus insulin delivery per day, age relative to the programmed basal a reduction in A1C of 1.0% or more in 2-unit increments. rate or by programming a new basal with lower total daily insulin require- Clinical studies using these novel rate. The temporary basal feature is ments, reduced risk of hypoglycemia, patch pumps for type 2 diabetes man- useful for situations in which insulin and higher treatment satisfaction agement have demonstrated improve needs may change drastically, but for a compared to MDI (25–28). These glycemic control, high patient satis- confined period, such as during acute benefits were obtained using relative- faction, reduced barriers to insulin illness or when exercising. ly simple insulin dosing regimens. pump treatment, and cost savings Users can program larger, discrete Participants required only one or two when compared to MDI therapy bolus doses of insulin for carbohy- basal rates, and use of the bolus cal- (32–34). drate consumption and high blood culator to determine bolus doses was Sensor Augmented Pump glucose corrections. Most insulin not associated with reduction in A1C Therapy (28). This result suggests that individ- pumps contain a bolus calculator with The development of CGM systems in uals with type 2 diabetes may not re- which the pump calculates a bolus the early 2000s was followed by the quire the complex pump features that dose recommendation based on the advent of the sensor augmented pump are beneficial for the management of current blood glucose value, current (SAP), which combines a CGM and type 1 diabetes (29) and that cited insulin on board (remaining active insulin pump in one system. A CGM barriers to conventional insulin pump insulin from previous bolus doses), device consists of three components: therapy for individuals with type 2 di- and total grams of carbohydrates that 1) a thin, flexible sensor, which is in- abetes, such as extensive educational the user enters into the pump. Some serted into the subcutaneous tissue requirements and high cost compared pumps have an extended bolus option, and continuously measures glucose to MDI, could be reduced with sim- which delivers a portion of the total levels in the interstitial fluid,2 ) a pler devices (30). bolus dose immediately and extends transmitter that sends the sensor glu- Thus, simplified pump technology the delivery of the remainder of the cose data to a receiver, and 3) a receiv- has been developed specifically target- dose over a longer period (usually er, which displays the glucose values. ing the needs of people with type 2 2–3 hours) to help prevent delayed In an SAP system, the insulin pump diabetes.
Recommended publications
  • Thinking of Starting Insulin
    Thinking of starting insulin Many medications are used to What happens in diabetes? manage diabetes, but the one that Type 1 diabetes most people have heard about is The pancreas is no longer able to make insulin. As a result, people diagnosed insulin. If you are thinking of starting with type 1 diabetes will need to start on insulin immediately and take it for insulin, here are some things you life. Insulin is given either with multiple daily injections using insulin pens or will want to know. syringes or by using an insulin pump. What is insulin? Type 2 diabetes Insulin is a hormone produced The pancreas no longer produces enough insulin or the body is not able to by the pancreas to control the use its own insulin effectively. If you have type 2 diabetes, you may be able amount of glucose (sugar) in the to keep your blood sugar levels in your target range through healthy eating, blood. Without insulin, sugar builds physical activity, and by taking diabetes medication. Ask your doctor to refer up in the bloodstream. This can you to a diabetes educator (nurse, dietitian, or pharmacist) who can help you lead to serious health problems, with lifestyle changes and managing your blood sugar levels. Type 2 diabetes such as blindness, heart disease, is a progressive condition and, over time, many people will need to use kidney problems, amputation, nerve insulin to manage their blood sugar. damage, and erectile dysfunction. How do I feel about starting insulin? Looking forward to good Sometimes people feel scared, nervous, or guilty about having to start insulin health therapy, and that’s okay.
    [Show full text]
  • Adult Glucose Monitoring Equipment, Insulin Pumps, and Supplies: FAQ's
    HEALTH EDUCATION HEALTH EDUCATION Adult Glucose Monitoring Equipment, Insulin Pumps, and Supplies: FAQ's Are glucose meters covered under my Health Plan benefit? Yes, home blood glucose meters and supplies are covered by your Health Plan benefit when your doctor prescribes them. The supplies Our goal is to find the include test strips, lancets, and lancing devices. The meter and best way to help you supplies are covered under a special benefit for members, called the manage your diabetes. Durable Medical Equipment (DME) benefit. These diabetes supplies You will work with your and all refills are available at any local Kaiser Permanente pharmacy. diabetes care team to Your health care provider may prescribe a home glucose meter and discuss your diabetes and supplies for you when: the equipment and • You have a diagnosis of diabetes; and supplies that may be • Blood sugar monitoring is medically necessary for you to control appropriate for you. your diabetes. What types of glucose meters are available at Kaiser Permanente? The LifeScan OneTouch® VerioTM IQ is the glucose meter that Kaiser Permanente health care providers prescribe most often. Some patients will have the OneTouch® Ultra® 2 meter instead, which is also an approved meter. Physicians may prescribe different meters for Kaiser Permanente members who are blind, have severe vision problems, or who have challenges using their hands and can’t use the OneTouch® VerioTM IQ meter. How many glucose meters are covered under my DME benefit? The DME benefit covers one working glucose meter at a time. You must have a valid prescription for a meter from your health care provider.
    [Show full text]
  • Research Article Impact of the Type of Continuous Insulin Administration on Metabolism in a Diabetic Rat Model
    Hindawi Publishing Corporation Journal of Diabetes Research Volume 2016, Article ID 8310516, 10 pages http://dx.doi.org/10.1155/2016/8310516 Research Article Impact of the Type of Continuous Insulin Administration on Metabolism in a Diabetic Rat Model A. Schaschkow,1 C. Mura,1 S. Dal,1 A. Langlois,1 E. Seyfritz,1 C. Sookhareea,1 W. Bietiger,1 C. Peronet,1 N. Jeandidier,1,2 M. Pinget,1,2 S. Sigrist,1 and E. Maillard1 1 UMR DIATHEC, EA 7294, Centre Europeen´ d’Etude du Diabete,` UniversitedeStrasbourg(UdS),BoulevardRen´ eLeriche,´ 67200 Strasbourg, France 2Department of Endocrinology, Diabetes, and Metabolic Diseases, Poleˆ NUDE, Hopitauxˆ Universitaires de Strasbourg (HUS), 67000 Strasbourg Cedex, France Correspondence should be addressed to E. Maillard; [email protected] Received 8 April 2016; Revised 26 May 2016; Accepted 14 June 2016 Academic Editor: Bernard Portha Copyright © 2016 A. Schaschkow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Exogenous insulin is the only treatment available for type 1 diabetic patients and is mostly administered by subcutaneous (SC) injection in a basal and bolus scheme using insulin pens (injection) or pumps (preimplanted SC catheter). Some divergence exists between these two modes of administration, since pumps provide better glycaemic control compared to injections in humans. The aim of this study was to compare the impacts of two modes of insulin administration (single injections of long-acting insulin or pump delivery of rapid-acting insulin) at the same dosage (4 IU/200 g/day) on rat metabolism and tissues.
    [Show full text]
  • Insulin Pump Therapy
    DIABETES TREATMENT ALGORITHMS SUPPLEMENT Insulin Pump Therapy Introduction The goal of insulin delivery is to regulate blood glucose levels to achieve normoglycemia. In someone without diabetes, pancreatic B-cells continuously secrete insulin throughout the day and night, providing a continuous insulin infusion or basal amount. In response to meals, the pancreas provides “bursts” of insulin referred to as boluses. Pump therapy is intended to more closely mimic this pancreatic function. Continuous subcutaneous insulin infusion (CSII) utilizes only fast acting insulins (Humalog, Novolog) and eliminates the use of long-acting insulins (NPH, Ultralente, Lantus). Pumps can deliver insulin in 0.1 unit increments as a basal/continuous flow between meals and through the night. Basal rates can be increased or decreased at any point, allowing for exercise, illness, skipped meals, sensitivity to insulin and the dawn phenomenon. Boluses of insulin can be delivered via the pump to provide insulin to compensate for carbohydrate intake and hyperglycemic episodes when needed. Insulin pump therapy gives people with diabetes the freedom to enjoy life, despite their chronic condition. The value of an improved lifestyle, increased flexibility and optimal diabetes control is obvious from the impact the insulin pump has made in the twenty-five years since its inception. The ability to control how and when insulin is delivered provides the “pumper” with increased flexibility in scheduling their day-to-day activities. For those people with erratic lifestyles, a desire to achieve optimal glycemic control (A1c ≤ 6.5%) and prevent chronic complications, the pump is an ideal choice. INDICATIONS FOR PUMP THERAPY Clinical Indications 1.
    [Show full text]
  • Subcutaneous Insulin Pump Management: Inpatient POLICY STATEMENT: PURPOSE: SCOPE: DEFINITIONS
    Current Status: Retired PolicyStat ID: 3428552 Effective: 03/2017 Approved: 03/2017 Last Revised: 03/2017 Expiration: 03/2020 Owner: Dustin Falk: Clinical Coordinator- Pharmacy Department: Pharmacy CSM References: Applicability: Columbia St. Mary's Hospital Milwaukee Columbia St. Mary's Hospital Ozaukee Sacred Heart Rehabilitation Institute Subcutaneous Insulin Pump Management: Inpatient POLICY STATEMENT: Inpatient insulin pump management requires careful coordination between the patient and medical staff. To provide safe and optimal care, a set of criteria must be met on admission and throughout the inpatient stay if the insulin pump is to be continued. All ADULT patients admitted with an insulin pump will be assessed using criteria outlined below. PURPOSE: To outlineRETIRED the roles and responsibilities related to caring for inpatients on an insulin pump. This policy refers to any ADULT patient admitted to the hospital who is using an external pump to manage his/her diabetes. Pediatric patients do not fall under the purview of this policy. SCOPE: This policy applies to all staff involved in the care of diabetic patients within the Columbia St. Mary's organization. DEFINITIONS: EHR: Electronic Health Record Insulin Pump: Battery operated device the size of a pager, which provides continuous 24 hour insulin delivery utilizing rapid acting insulin. Insulin is delivered through a needle or soft cannula that is inserted into the patient's subcutaneous tissue and connected to thin plastic tubing attached to the pump or has no tubing in the case of Omnipod™ pump. The pump mimics normal pancreatic function and is programmed by the patient to deliver insulin via basal rates and at each meal as a bolus dose.
    [Show full text]
  • The Leeds Insulin Pump Workbook for Children and Young People
    The Leeds Insulin Pump Workbook for Children and Young People IABETES A service for children and LEEDS young people with diabetes YORKSHIRE This project has received funding from Medtronic Contents Welcome to the insulin pump workbook Introduction Starting pump therapy 1.1 Why is insulin necessary? 2.1 Getting started 1.2 Insulin pump therapy 2.2 Calculate and set basal rate 1.3 Benefits of insulin pump therapy 2.3 Calculate insulin to carbohydrate ratio 1.4 What types of insulin are used in a pump? 2.4 Calculate the correction dose 1.5 The basics of insulin pumps 2.5 Pump failure 1.6 Blood glucose monitoring and HbA1c 2.6 Removing the pump 1.7 End of section worksheet 2.7 Temporary basal rates 2.8 Emergency kit 1 2.9 End of section worksheet 2 Managing pump therapy Diet 3.1 Hypoglycaemia 4.1 Carbohydrate counting 3.2 Hyperglycaemia 4.2 Glycaemic index 3.3 Ketones 4.3 Advanced bolus options 3.4 Illness and diabetic ketoacidosis 4.4 End of section worksheet 3.5 Checking basal rate 3.6 Checking insulin to carbohydrate ratio 3.7 Continuous glucose monitoring and meter/pump downloads 3.8 A structured approach to interpretation of blood glucose readings 3.9 End of section worksheet 3 4 Life Appendices 5.1 Exercise and activity Appendix A: Record of insulin pump settings 5.2 Travel Appendix B: Adjusting basal rate charts 5.3 School/College and social life Appendix C: Useful websites/books and support groups 5.4 Illness Appendix D: Needle information 5.5 Menstruation Appendix E: End of section worksheet answers 5.6 Alcohol Appendix F: Glossary 5.7 Admission to hospital 5.8 Continuation of funding 5.9 Insurance 5.10 Identification of a medical issue 5.11 End of section worksheet 5 Welcome Welcome to your insulin pump workbook.
    [Show full text]
  • When Intensive Insulin Therapy (MDI)
    S180 Diabetes Care Volume 39, Supplement 2, August 2016 1 2 INSULIN THERAPY Ohad Cohen, Sebastiano Filetti, When Intensive Insulin Therapy Javier Castaneda,~ 3 Marianna Maranghi,2 (MDI) Fails in Patients With and Mariela Glandt4 Type 2 Diabetes: Switching to GLP-1 Receptor Agonist Versus Insulin Pump Diabetes Care 2016;39(Suppl. 2):S180–S186 | DOI: 10.2337/dcS15-3029 Treatment with insulin, alone or with oral or injectable hypoglycemic agents, is becoming increasingly common in patients with type 2 diabetes. However, approximately 40% of patients fail to reach their glycemic targets with the initially prescribed regimen and require intensification of insulin therapy, which increases the risks of weight gain and hypoglycemia. Many of these patients eventually reach a state in which further increases in the insulin dosage fail to improve glycemic control while increasing the risks of weight gain and hypoglycemia. The recently completed OpT2mise clinical trial showed that continuous subcutaneous insulin infusion (CSII) is more effective in reducing glycated hemoglobin (HbA1c) than intensification of multiple daily injection (MDI) insulin therapy in patients with type 2 diabetes who do not respond to intensive insulin therapy. CSII therapy may also be useful in patients who do not reach glycemic targets despite multi- drug therapy with basal-bolus insulin and other agents, including glucagon-like peptide (GLP)-1 receptor agonists; current guidelines offer no recommendations for the treatment of such patients. Importantly, insulin and GLP-1 receptor ago- nists have complementary effects on glycemia and, hence, can be used either sequentially or in combination in the initial management of diabetes. Patients 1 who have not previously failed GLP-1 receptor agonist therapy may show reduc- Sheba Medical Center, Tel Hashomer, Israel 2Dipartimento di Medicina Interna e Specialita` tion in weight and insulin dose, in addition to moderate improvement in HbA1c, Mediche, Sapienza University, Rome, Italy when GLP-1 receptor agonist therapy is added to MDI regimens.
    [Show full text]
  • Insulin Replacement Therapy
    Diabetes Educational Services Training Healthcare Professionals On State of the Art Diabetes Care Insulin Replacement Therapy Another Downloadable Article from the Diabetes Educational Services Site Insulin Replacement Therapy is an excellent review of strategies to effectively dose and adjust insulin for patients with type 1 and type 2 diabetes. It is authored by our faculty member, Evelyne Fleury Milfort. Diabetes Educational Services Beverly Dyck Thomassian 45 Old Chico Way Chico, CA 95928 530 893-8635 [email protected] http://www.diabetesed.net/ Insulin Replacement Therapy Vol. 16 •Issue 11 • Page 32 2009 Diabetes CE Insulin Replacement Therapy Minimizing Complications and Side Effects by Evelyne Fleury-Milfort, NP Objectives: The purpose of this article is to educate nurse practitioners about insulin replacement therapy. After reading this article, the nurse practitioner should be able to: * define insulin replacement therapy and discuss appropriate candidates for this form of insulin management * describe the major components of insulin replacement therapy * identify criteria for choosing insulin regimen modalities * explain the initiation and titration process for multiple daily injections and insulin pump therapy. Insulin therapy is the cornerstone of treatment for all patients with type 1 diabetes and for patients with type 2 diabetes who reach severe beta cell failure. Multiple studies have documented the importance of optimal glucose control to prevent the devastating complications of the disease. The best strategy to achieve optimal glucose control is to imitate normal insulin delivery. This continuing education article discusses strategies for the initiation and titration of insulin replacement therapy. Current State of Diabetes Diabetes has reached an epidemic level in the United States.
    [Show full text]
  • Providers | External Insulin Pump Policy
    PROVIDER POLICIES & PROCEDURES _________________________ CONTINUOUS SUBCUTANEOUS INSULIN INFUSION PUMPS (CSII) The primary purpose of this document is to assist providers enrolled in the Connecticut Medical Assistance Program with the information needed to support a medical necessity determination for external insulin pumps. By clarifying the information needed for prior authorization of services, HUSKY Health hopes to facilitate timely review of requests so that individuals obtain the medically necessary care they need as quickly as possible. A continuous subcutaneous insulin infusion pump is a programmable, computerized device that is used to deliver a continuous subcutaneous insulin infusion into the body. Typically, these devices contain a 2-3 day supply of insulin connected to an infusion set or pod programmed to deliver basal amounts of insulin and bolus doses. The purpose of the device is to provide an accurate, continuous, controlled delivery of insulin to achieve improved glycemic control and to minimize and/or prevent acute and chronic complications. An external insulin pump is considered durable medical equipment (DME). CLINICAL GUIDELINE Coverage guidelines for insulin pumps for the treatment of diabetes are made in accordance with the Department of Social Services (DSS) definition of Medical Necessity. The following criteria are guidelines only. Coverage determinations are based on an assessment of the individual and his or her unique clinical needs. If the guidelines conflict with the definition of Medical Necessity, the definition of Medical Necessity shall prevail. The guidelines are as follows: Initial Insulin Pump Therapy Initial Pump Therapy without Continuous Glucose Monitoring (CGM) Integration The administration of insulin by an external continuous subcutaneous insulin infusion pump in an individual with diabetes requiring insulin therapy may be considered medically necessary when: A.
    [Show full text]
  • Exploring the Challenges Insulin Pump Technologies
    Exploring the Challenges & designing potential solutions for Insulin Pump Technologies Andy Harper - MID Candidate August, 2020 Wendell Wilson - Project Advisor Leila Aflatoony - Committee Member Wei Wang - Committee member 1 Acknowledgements First and foremost, I would like to acknowledge the diabetes community, the practitioners of Atlanta Diabetes Associates, and The Juvenile Diabetes Research Foundation for investing their time, recourses, and enthusiasm in helping me with this research. I approached you with very little to offer, and a lot to learn. You taught me enough to have a new outlook on living with T1 diabetes. It was an honor to share stories with other people living with T1D, and to learn about all the work that so many of you do to help people like myself. This was a totally affirming, enlightening, and humbling experience. Thank you to my advisor Wendell Wilson and committee members, Wei Wang and Leila Aflatoony. You were persistent and honest guides throughout the entire project. You pushed me to do some of my best work. Thank you for sharing your knowledge and experience in physical product design, research and analysis, experience design, and strategy. You gave me a renewed sense of self-confidence in my abilities and I have gotten to know myself better, as a designer. I am incredibly fortunate to have worked so closely with all of you! I can’t thank you enough for investing in me. 2 3 5-stage Project Abstract This study examines the current technology of diabetes Methodology management devices, primarily insulin pumps. Insulin pumps are effective tools for the precise control of glucose levels, for type 1 Phase 1: Background Research diabetes (T1D) patients.
    [Show full text]
  • Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes
    UnitedHealthcare® Commercial Medical Policy Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes Policy Number: 2021T0347GG Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policy Coverage Rationale ....................................................................... 1 • Durable Medical Equipment, Orthotics, Medical Documentation Requirements ...................................................... 2 Supplies and Repairs/Replacements Applicable Codes .......................................................................... 2 Description of Services ................................................................. 6 Community Plan Policy Benefit Considerations .................................................................. 7 • Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes Clinical Evidence ........................................................................... 7 U.S. Food and Drug Administration ........................................... 13 Medicare Advantage Coverage Summary References ................................................................................... 14 • Diabetes Management, Equipment and Supplies Policy History/Revision Information ........................................... 16 Instructions for Use ..................................................................... 16 Coverage Rationale See Benefit Considerations Insulin Delivery External insulin pumps that deliver insulin by continuous subcutaneous infusion are
    [Show full text]
  • Insulin Pumps and Supplies Clinical Coverage Criteria Overview an External Insulin Pump Is a Device That Delivers Insulin Subcutaneously
    Insulin Pumps and Supplies Clinical Coverage Criteria Overview An external insulin pump is a device that delivers insulin subcutaneously. The insulin is delivered in a programmed and controlled manner and eliminates the need for the patient to self-inject insulin. The main goal in using an insulin pump is to achieve near normal blood glucose levels in order to prevent both acute and chronic complications of diabetes. Policy This Policy applies to the following Fallon Health products: ☒ Commercial ☒ Medicare Advantage ☒ MassHealth ACO ☒ NaviCare ☒ PACE Fallon Health follows guidance from the Centers for Medicare and Medicaid Services (CMS) for organization (coverage) determinations for Medicare Advantage plan members. National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Local Coverage Articles (LCAs) and guidance in the Medicare manuals are the basis for coverage determinations. When there is no NCD, LCD, LCA or manual guidance, Fallon Health Clinical Coverage Criteria are used for coverage determinations. Medicare Benefit Policy Manual, Chapter 20, Section 110 describes the durable medical equipment benefit and coverage of supplies and accessories that are necessary for the effective use of durable medical equipment for Medicare beneficiaries. Medicare does not have an NCD for insulin pumps. Noridian Healthcare Solutions, LLC is the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) with jurisdiction in our service area. Noridian Healthcare Solutions, LLC has an LCD for (MCD search 06-25-2021). For plan members enrolled in NaviCare and PACE plans, Fallon Health follows Medicare guidance for coverage determinations. In the event that there is no Medicare guidance or if the plan member does not meet medical necessity criteria in Medicare guidance, Fallon Health will follow guidance published by MassHealth.
    [Show full text]