Effects of continuous subcutaneous insulin infusion (CSII) therapy on quality of life and patients' self-management: Clinical survey of routine clinical practice at Derby Teaching Hospital, UK
Continuous subcutaneous insulin infusion (CSII) therapy for Type 1 diabetes can provide long-term, sustained improvements in glycaemic control and a reduction in hypoglycaemia. We aimed to assess the impact of CSII on quality of life and confidence in diabetes management. Methods: Patient-level data were obtained from the hospital electronic records for 220 CSII users from the Royal Derby Hospital. Patient confidence and satisfaction questionnaires were sent by post. A Likert scale was used to assess confidence in aspects of self-management. STATA v.13 was used for data analysis. Results: 54% (n = 119) responded; mean age 47.8 +/- 14.1 years; 58.8% female. Pre-CSII HbA1c was 9.1 +/- 1.8%; CSII duration 4.3 years (interquartile range 2.6+/-7.2) and most recent HbA1c 8.2 +/- 1.2%. 82.4% (n = 98) had pre-CSII structured education. Almost all patients reported that CSII improved their quality of life (94.2%, n = 114) and reduced the frequency of hypoglycaemia (79.8%, n = 95). The majority felt confident to carbohydrate count (90.8%, n = 108); check blood glucose >4/day (80.1%, n = 105); test and adjust CSII basal rates (69.7%, n = 83; 80.7%, n = 96 respectively). A quarter did not feel confident to use sick day rules (26.9%, n = 32) or adjust their insulin:carbohydrate ratio (26%, n = 31). Many were not confident in the use of advanced bolus features (45.4%, n = 54) or exercising without upsetting blood glucose (33.6%, n = 40). 85.7% (n = 102) were satisfied with the quality of care received. Conclusions: CSII improved quality of life and, overall, users were confident to self-manage their diabetes. Use of advanced pump features, sick day rules and exercise were identified as areas to target in future education interventions.