Yasmin H AbdulAziz1, Hesham S Al-Sallami1, Esko Wiltshire2, Jenny Rayns3, Jinny Willis4, Joanna McClintock5, Natalie Medlicott1, Benjamin J Wheeler3,6. 1. 1School of Pharmacy, University of Otago, Dunedin, 9054 New Zealand. 2. 2Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand. 3. Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. 4. Don Beaven Medical Research Hospital, Christchurch, New Zealand. 5. 5Paediatric Diabetes, Waikato District Health Board, Hamilton, New Zealand. 6. 6Women's and Children's Health, University of Otago, Dunedin, New Zealand.
Abstract
PURPOSE: Worldwide, the use of insulin pumps for the management of type 1 diabetes is increasing. There are no national or international published guidelines and few guidance recommendations detailing the education and training required to commence insulin pump therapy. The aim of this study is to describe current clinical practice regarding initiation of insulin pump therapy in children and adolescents with type 1 diabetes in New Zealand. METHODS: Pediatric diabetes nurse specialists from selected New Zealand hospitals (n = 16) were identified and invited to participate in this qualitative study. For those consenting, structured interviews were conducted. The questions covered basic hospital demographics and various aspects of insulin pump initiation including pump start planning, education, and aspects of follow-up and after-care. RESULTS: The response rate was 100% (16 out of 16 hospitals). Diabetes clinics interviewed varied in size from 50 to 450 pediatric patients and frequency of insulin pump use from 11% - 46%. Clinical practice differed between clinics. Important differences related to: use of continuous glucose monitoring (12/16); and differing views on immediate vs. delayed use of pump advanced features. Location of pump starts also varied, with both in-patient (2/16) and out-patient (14/16) approaches seen. The motivations and beliefs relating to these various pump start approaches also varied. CONCLUSIONS: Differences seen between hospitals reflected team preference, and possibly a lack of consensus/guidance from the medical literature. Lessons may be learnt and further rationalisation and improvement in education remains possible by combining and adopting strengths from different hospitals.
PURPOSE: Worldwide, the use of insulin pumps for the management of type 1 diabetes is increasing. There are no national or international published guidelines and few guidance recommendations detailing the education and training required to commence insulin pump therapy. The aim of this study is to describe current clinical practice regarding initiation of insulin pump therapy in children and adolescents with type 1 diabetes in New Zealand. METHODS: Pediatric diabetes nurse specialists from selected New Zealand hospitals (n = 16) were identified and invited to participate in this qualitative study. For those consenting, structured interviews were conducted. The questions covered basic hospital demographics and various aspects of insulin pump initiation including pump start planning, education, and aspects of follow-up and after-care. RESULTS: The response rate was 100% (16 out of 16 hospitals). Diabetes clinics interviewed varied in size from 50 to 450 pediatric patients and frequency of insulin pump use from 11% - 46%. Clinical practice differed between clinics. Important differences related to: use of continuous glucose monitoring (12/16); and differing views on immediate vs. delayed use of pump advanced features. Location of pump starts also varied, with both in-patient (2/16) and out-patient (14/16) approaches seen. The motivations and beliefs relating to these various pump start approaches also varied. CONCLUSIONS: Differences seen between hospitals reflected team preference, and possibly a lack of consensus/guidance from the medical literature. Lessons may be learnt and further rationalisation and improvement in education remains possible by combining and adopting strengths from different hospitals.
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