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

Jeffrey A. Sanfield, MD, CDE, FACP

St. Joseph Mercy Hospital, Ann Arbor, Michigan, Eastern Michigan University, Ypsilanti, Michigan

Marcia Hegstad, CNS, CDE, BC-ADM

61242 Greenwood Drive, South Lyon, Michigan 48178 hegstadm{at}trinity-health.org

Raouf S. Hanna, PhD

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 21/2 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 21/2 years.

The Diabetes Educator, Vol. 28, No. 4, 599-607 (2002)
DOI: 10.1177/014572170202800414
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