CSII from patient to politics; a national and local perspective

Continuous subcutaneous infusion of insulin (CSII), or insulin pump therapy, is increasingly recognised as an important treatment option for type 1 diabetes. In the UK, however, patient usage remains low, owing in part to the politics surrounding funding. In this article, current CSII use in Scotland is discussed and the evidence base and cost effectiveness of the therapy, with respect to biochemical parameters and quality of life reviewed. The guidance on CSII use from national organisations (Scottish Intercollegiate Guideline Network and the National Institute for Health and Clinical Excellence) is also presented. There is strong support for CSII among patients, and personal patient stories are included to highlight the potential impact of CSII on everyday life. Finally, we discuss our local strategy for recruiting and commencing pump therapy and the local and national challenges faced. As CSII use increases, it is important that all doctors, nurses and allied health professionals have an awareness of what it is and how it works. Patients need ongoing support to best manage their health and health professionals should ensure that the most appropriate and cost-effective therapies are being offered.