Selection Criteria for Insulin Pumps & AID

Assisting With Pump & Infusion Set Selection

Helping people with diabetes (PWD) select the equipment that is best suited to their needs is integral to successful diabetes management. While all insulin pumps, infusion sets and insertion devices have basic attributes in common, there are key differences that can impact individual suitability.

Although most insulin pumps may be returned within 30 days of purchase, it is uncommon for a person with diabetes to do so. In some cases, once the 30-day period has passed, the user will not be eligible to “switch” or “upgrade” until the pump’s warranty expires. However, this is not as common today, especially as more AIDs are covered as pharmacy benefits, making a switch a little easier.

Individuals who are not exposed to or educated on their options may find themselves with a device that is ill-fitted to their needs. It is the responsibility of the diabetes care and education specialist and other health care providers to stay current with all the commercially available insulin pumps, integrated sensor options, infusion sets and insertion devices.

Pump Selection Criteria

When the decision has been made to initiate pump therapy, the starting point is verification of the individual’s insurance or, if applicable, self-pay coverage. Most private health insurance plans allow their members to choose any type of insulin pump and infusion set. However, government-based plans and, occasionally, private plans will only pay for specific brands. For unbiased and detailed comparisons of insulin pump features, visit our product comparison pages. Also, consider referrals to the various manufacturers for “test drives” of their top choices.

When a list of covered pump models is determined, the following qualities should be considered:

• Insulin Volume: Does the pump hold enough to last the patient 2-3 days? Are basal rate increments small enough?
• Screen Legibility: Can the patient read all on-screen text?
• Alarm and Alert Recognition:  Can the user hear or feel them?
• Waterproof: Is it needed by the user?
• Download Capability: Is the software easy for the patient to download and review? Does the download data provide cloud technology to allow the provider to access the data?
• CGM Data: Is it linked with CGM?
• Pump and CGM Integration: Does the pump respond to sensor data by adjusting basal rate? Correctional insulin? Suspend prior to low?
• Interface with Point-in-Time Blood Glucose Meters: Does the meter communicate directly with the insulin pump?
• Remote Control Capabilities: Is it desired/needed by the user or caregiver?
• Infusion Device Compatibility: Which options are available? Are they suited to the needs of the patient?
• Complexity of user programming: Is the menu layout simple? How many button presses are needed for basic programming? Look and feel of the device size, weight, color and wearing options (clips, cases) desirable for patient?
• Special Alerts and Reminders: Are site change, missed bolus, and customizable reminders and alerts needed?
• Tubing vs. “Patch” Style: Will tubing be a significant hindrance?
• Customer Support: What is the company’s reputation and stability?

Infusion Set Selection

Just as certain insulin pumps are better suited to certain individuals, so are infusion sets and set insertion devices. Many pumps allow the user to choose from a variety of infusion set types and some use proprietary sets that are only compatible with the manufacturer’s pump. An initial assessment of body composition and the individual lifestyle is necessary to determine the appropriate type of infusion set.⁷

Variables to consider when selecting an infusion set include Teflon^® cannula versus metal needle, tubing and cannula or needle length, disconnect and insertion mechanisms, angle of insertion, adhesion and aesthetics.⁸ If an infusion set is not specified when the insulin pump is ordered, a “default” infusion set will be sent. Use of a poorly matched infusion set can result in frustration and potential for discontinuation of insulin pump therapy.

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References:

^{American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. ADCES Insulin Pump Therapy Guidelines, ISPAD Clinical Practice Consensus Guidelines 2022: Insulin Pump Therapy. Endocrine Society. Management of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM). Clinical Research on Insulin Pumps & Automated Insulin Delivery (AID) Systems: Beck RW, Riddlesworth T, et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA, 2017.}