The Clinical Perspective
Irl B. Hirsch, MD, who is a professor of medicine and the Diabetes Treatment and Teaching Chair at the University of Washington in Seattle, agreed with Dr. Peters, noting that there is a great need for improvement in the area of insulin pump safety.
The new recommendations are an important start, Hirsch said, and he believes that many physicians who read them will be surprised about the current lack of transparency from the pump companies when it comes to reporting returned pumps, device malfunction and the frequency of human error.
“What is important to realize is that in the U.S., the models of care are so different from practice to practice, and that could influence safety,” Hirsch said. “For example, in adults, one could be in a large academic multidisciplinary center with a full complement of educators and both the physicians and non-physicians are familiar with advanced pump strategies. There are other practices, both academic and private, where the physicians have minimal role in the pump teaching/management from visit to visit.”
Depending on how often the patient meets with the diabetes educator, critical self-management knowledge is forgotten or never obtained, he said. There are practices where the physician may prescribe insulin pumps, but he or she is not as familiar with the specifics of their use as they should be while at the same time, there are no educators associated with the practice.
“The pump companies have tried to avert the problem by hiring their own educators to help teach patients, but one could argue this is not a good solution since, with some exceptions, the company is mostly involved with initial teaching not ongoing management. Either way, the educator in the office or from the company adds to the cost of the care and thus this is a situation without a good solution,” Hirsch told Endocrinology Advisor.
The new recommendations by the working group call for compiling systematic data on the durability and precision of insulin pumping over years of real-world clinical usage and open data on the results of testing pumps that are recalled or returned.
The working group also said there should be set standards for levels of staffing and skills required by teams of health care professionals providing initial and ongoing education and support for pump users.
Further, Peters and her colleagues are calling for public funding of more research addressing clinically important questions in relation to pump therapy. They believe both observational studies and clinical trials are warranted.