Protocol for Outpatient Screening and Initiation of Continuous Subcutaneous Insulin Infusion Therapy: Impact on Cost and Quality

Abstract

PURPOSE the purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 ¹A years. METHODS One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2½ years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin Al C (Al C) were measured and compared. RESULTS The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). Al C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections. CONCLUSIONS A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2½ years.