International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 1023–1030 | Cite as

Insulin pump therapy: impact on the lives of children/young people with diabetes mellitus and their parents

  • Fatemah M. AlsalehEmail author
  • Felicity J. Smith
  • Rebecca Thompson
  • Mohammad A. Al-Saleh
  • Kevin M. G. Taylor
Research Article


Background Advances in medical technology and research documenting clinical effectiveness have led to the increased use of insulin pumps worldwide. However, their use by children in the UK is relatively limited and there is little evidence regarding their impact on patients’ lives. Objective This study aimed to examine the impact of switching from multiple daily injections to insulin pumps on the glycaemic control and daily lives of children/young people and their families. Setting University College London Hospital, London. Method Face-to-face semi-structured interviews were conducted with children/young people with type 1 diabetes mellitus (5–17 years; N = 34) and their parents (N = 38), receiving insulin pump therapy and attending paediatric diabetes outpatients clinics at a major university teaching hospital in London. Glycated haemoglobin A1c values from 6 months prior to, and after pump therapy were obtained. Qualitative and quantitative approaches were undertaken for data analysis. Main outcome measure Glycated haemoglobin A1c and the impact of the use of insulin pumps on the children and their families. Results The majority of parents (N = 32) and the children/young people (N = 30) reported that glycaemic control was easier to maintain within the target range with pumps compared to injections. This was supported by glycated haemoglobin A1c measures. Participants generally found the devices easy to use and more acceptable than injections. However, parents and children/young people reported many challenges in the early stages of pump therapy (e.g. 7 children/young had worse control at 6 months after starting CSII). Parents and children/young people reported an overall increase in lifestyle flexibility and an improved ability to participate in home, school and social activities whilst maintaining glycaemic control. Conclusion Administration of insulin via pumps rather than injections was generally preferred. Participants reported most difficulty at the commencement of use. Pump therapy conferred benefits in terms of glycaemic control, general well-being, enabling young people to be more in control of their condition and live more normal lives, as reported by most participants. These are important goals of health policy for children/young people with long-term conditions in the UK.


Adolescents Children Insulin pumps Type 1 diabetes mellitus United Kingdom 



The authors wish to acknowledge C/YP and their parents who contributed in the study. Also deep appreciation and acknowledgement should go to the diabetes team at UCLH who helped to make this research possible. We also thank Dr. Derek Cooper (King’s College, London) for assistance in analysing the quantitative data reported.


All funding was made as part of a research studentship by Kuwait University, Kuwait.

Conflicts of interest

There is no conflict of interest.


  1. 1.
    The Medical Technology Group, INPUT, Sanders A. Pump action: a review of insulin pump uptake and NICE guidance in English PCTs. United Kingdom; 2010. Available from: Accessed 1 Jan 2014. No ISBN available.
  2. 2.
    Department of Health. National Service Framework for children, young People, and maternity services: key issues for primary care. London; 2004. Available from: Accessed 16 Nov 2013. No ISBN available.
  3. 3.
    Diabetes UK. The United Kingdom insulin pump audit-service level data [internet]. United Kingdom; 2013. Available from: Accessed 2 Jun 2014. No ISBN available.
  4. 4.
    Pankowska E, Blazik M, Dziechciarz P, Szypowska A, Szajewska H. Continuous subcutaneous insulin infusion versus multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials. Practical Diabetes International. 2009;10:52–8.Google Scholar
  5. 5.
    Cummins E, Royle P, Snaith A, Greene A, Robertson L, McIntyre L, et al. Clinical effectiveness and cost-Effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation. Health Technol Assess. 2010;14:1–181.Google Scholar
  6. 6.
    Shalitin S, Gil M, Nimri R, de Vries L, Gavan MY, Phillip M. Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy. Diabet Med. 2010;27:339–47.PubMedCrossRefGoogle Scholar
  7. 7.
    Sulli N, Shashaj B. Continuous subcutaneous insulin infusion in children and adolescents with diabetes mellitus: decreased HbA1c with low risk of hypoglycemia. J Pediatr Endocrinol Metab. 2003;16:393–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Weinzimer SA, Ahern JH, Doyle EA, Vincent MR, Dziura J, Steffen AT, et al. Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report. Pediatrics. 2004;114:1601–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Mack-Fogg JE, Orlowski CC, Jospe N. Continuous subcutaneous insulin infusion in toddlers and children with type 1 diabetes mellitus is safe and effective. Pediatr Diabetes. 2005;6:17–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Hanas R, Adolfsson P. Insulin pumps in pediatric routine care improve long-term metabolic control without increasing the risk of hypoglycemia. Pediatr Diabetes. 2006;7:25–31.PubMedCrossRefGoogle Scholar
  11. 11.
    Sulli N, Shashaj B. Long-term benefits of continuous subcutaneous insulin infusion in children with Type 1 diabetes: a 4-year follow-up. Diabet Med. 2006;23:900–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson SR, Cooper MN, Jones TW, Davis EA. Long-term outcome in children with type 1 diabetes assessed in a large population-based case-control study. Diabetologia. 2013;56:2392–400.PubMedCrossRefGoogle Scholar
  13. 13.
    Batajoo RJ, Messina CR, Wilson TA. Long-term efficacy of insulin pump therapy in children with type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol. 2012;4:127–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Knight SJ, Northam EA, Cameron FJ, Ambler GR. Behaviour and metabolic control in children with Type 1 diabetes mellitus on insulin pump therapy: 2-year follow-up. Diabet Med. 2011;28:1109–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Lowes L. Insulin pump therapy: impact on QOL for children and parents. Practical Diabetes International. 2008;25:268.CrossRefGoogle Scholar
  16. 16.
    Barnard K, Lloyd C, Skinner T. Systematic literature review: quality of life associated with insulin pump use in type 1 diabetes. Diabet Med. 2007;24:607–17.PubMedCrossRefGoogle Scholar
  17. 17.
    Alsaleh FM, Smith FJ, Taylor KMG. Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review. J Clin Pharm Ther. 2012;37:140–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Sullivan-Bolyai S, Knafl K, Tamborlane W, Grey M. Parents’ reflections on managing their children’s diabetes with insulin pumps. J Nurs Scholarsh. 2004;3:316–23.CrossRefGoogle Scholar
  19. 19.
    Wilson V. Experiences of parents of young people with diabetes using insulin pump therapy. Paediatr Nurs. 2008;20:14–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Maniatis AK, Toig SR, Klingensmith GJ, Fay-Itzkowitz E, Chase HP. Life with continuous subcutaneous insulin infusion (CSII) therapy: child and parental perspectives and predictors of metabolic control. Pediatr Diabetes. 2001;2:51–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Low KG, Massa L, Lehman D, Olshan JS. Insulin pump use in young adolescents with type 1 diabetes: a descriptive study. Pediatr Diabetes. 2005;6:22–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Olinder A, Kernell A, Smide B. Continuous subcutaneous insulin infusion in young girls: a two-year follow-up study. European Diabetes Nursing. 2007;4:34–9.CrossRefGoogle Scholar
  23. 23.
    Lincoln YS, Guba EG. Naturalistic inquiry. 1st ed. California: SAGE; 1985. ISBN 0-8039-2431-3.Google Scholar
  24. 24.
    Meneghini L, Sparrow-Bodenmiller J. Practical aspects and considerations when switching between continuous subcutaneous insulin infusion and multiple daily injections. Diabetes Technol Ther. 2010;12:S109–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Campbell F. Review: The pros and cons of continuous subcutaneous insulin infusion (CSII) therapy in the paediatric population and practical considerations when choosing and initiating CSII in children. Br J Diabetes Vasc Dis. 2008;8:S6–10.CrossRefGoogle Scholar
  26. 26.
    Bennett K, Joseph F. Diabetes requiring insulin: recent developments in management. Prescriber. 2013;24:21–31.CrossRefGoogle Scholar
  27. 27.
    Barnard K, Speight J, Skinner T. Quality of life and impact of continuous subcutaneous insulin infusion for children and their parents. Practical Diabetes International. 2008;25:278–83.CrossRefGoogle Scholar
  28. 28.
    Department of Health. National Service Framework for Diabetes: standards. United Kingdom: The Stationary Office; 2001; Available from: Accessed 7 Dec 2013. No ISBN available.
  29. 29.
    NHS Diabetes. NHS diabetes insulin pump network [internet]. United Kingdom: NHS; 2013. Available from: Accessed 5 Jul 2013. No ISBN available.
  30. 30.
    Alsaleh FM, Smith FJ, Keady S, Taylor KMG. Insulin pumps: from inception to the present and toward the future. J Clin Pharm Ther. 2010;35:128–38.CrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Fatemah M. Alsaleh
    • 1
    Email author
  • Felicity J. Smith
    • 2
  • Rebecca Thompson
    • 3
  • Mohammad A. Al-Saleh
    • 4
  • Kevin M. G. Taylor
    • 5
  1. 1.Department of Pharmacy Practice, Faculty of PharmacyKuwait UniversitySafatKuwait
  2. 2.Department of Practice and Policy, UCL School of PharmacyUniversity of LondonLondonUK
  3. 3.University College HospitalLondonUK
  4. 4.Department of Statistics, College of Business StudiesThe Public Authority for Applied Education and Training (PAAET)AdailiyaKuwait
  5. 5.Department of Pharmaceutics, UCL School of PharmacyUniversity of LondonLondonUK

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