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.

Find infusion sets for a variety of insulin pumps

Find & compare insulin pumps

References:

^{1. Bergenstal R, Tamorlane W, Ahmann A et al. Effectiveness of sensor-augmented insulin-pump therapy in Type 1 diabetes. N Engl J Med. 2010:363:311-320. 2. Bally L, Hood T and Hovorka R. Closed-loop for Type 1 diabetes-an introduction and appraisal for the generalist. BMC Medicine. 2-17:15:14. Accessed 8/26/2017/ 3. Heinemann L, Fleming G, Petrie J et al. Insulin Pump Risks and Benefits: A Clinical Appraisal of Pump Safety Standards, Adverse Event Reporting, and Research Needs A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care 2015;38:716–722. 4. Grunberger G, Abelseth J, Bailey T, et al. (2014) Consensus Statement by the American Association of Clinical Endocrinologists/American College of Endocrinology Insulin Pump Management Task Force. Endocrine Practice: 2014:20(5) 463-489. 5. Decision Memo for Insulin Pump: C-Peptide Levels as a Criterion for Use (CAG-00092R) available: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=109&. Accessed 9/6/2017 6. Beck J, Greenwood D, Blanton L et al. 2017 National Standards for Diabetes Self-Management Education and Support. https://doi.org/10.2337/dci17-0025. Accessed 9/9/2017. 7. Walsh J, Roberts R. Pumping Insulin: Everything for Success on an Insulin Pump and CGM. 6th Edition. Torrey Pines Press, 2016 8. McCrea, D. A Primer on Insulin Pump Therapy for Health Care Providers. Nurs Clin N Am 52 (2017) 553–564. 9. Bolderman K. “Pump Start-Up” in Putting Your Patients on the Pump. Alexandria VA: American Diabetes Association 2013. 10. Standards of Medical Care in Diabetes--2017. Diabetes Care. 2017;40 Suppl 1:S48-57. 11. Handelsman Y, Mechanick JI, Blonde L, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17 Suppl 2:1-53. 12. Clayton-Jeter H. Contributing Factors to Insulin Pump Errors in Children, Adolescents and Adults Available: http://www.fda.gov/forhealthprofessionals/articlesofinterest/ucm295562.htm. Accessed February 13, 2014. 13. Aldasouqi S and Reed A. Pitfalls of insulin pump clocks: technical glitches that may potentially affect medical care in patient with diabetes. J Diabetes Sci Technol 2014;8(6):1215-1220. 14. Evert AB, Insulin pump therapy troubleshooting for optimal performance. Empower. 2015;7(4):23-24 15. Guilhem I, Leguerrier AM, Lecordier F, et al. Technical risks with subcutaneous insulin infusion. Diabetes Metab. 2006;32(3):279-284. 16. Maahs D, Horton L and Chase H. The use of insulin pumps in youth with Type 1 diabetes. Diabetes Technol Ther 2010;12(suppl1):S59-65. 17. Cornish A, Chase HP. Navigating airport security with an insulin pump and/or sensor. Diabetes Technol Ther. 2012;14(11):984-985. 18. American Diabetes Association. Fact Sheet – Air Travel and Diabetes Available: http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/publicaccommodations/air-traveland-diabetes/what-can-i-bring-with-me.html?referrer=https://www.google.com/. Accessed 9/10/2017 19. Diabetes care in the school and day care setting. Diabetes Care. 2014;37 Suppl 1:S91-96. 20. McCrea D. Management of the hospitalized diabetes patient with an insulin pump. Crit Care Nurs Clin North Am. 2013;25(1):111-121. 21. Boyle ME, Seifert KM, Beer KA, et al. Guidelines for application of continuous subcutaneous insulin infusion (insulin pump) therapy in the perioperative period. J Diabetes Sci Technol. 2012;6(1):184- 190. 22. Buchko BL, Artz B, Dayhoff S, et al. Improving care of patients with insulin pumps during hospitalization: translating the evidence. J Nurs Care Qual. 2012;27(4):333-340. 23. Rodbard D. Continuous Glucose Monitoring: A Review of Successes, Challenges and Opportunities. Diabetes Technol Ther. 2016;18(Suppl2):S2-3-S2-13. 24. https://www.diabeteseducator.org/practice/practice-documents/practice-papers © Copyright © 2021 Association of Diabetes Care & Education Specialists. All rights reserved Reproduction or republication strictly prohibited without prior written permission 13 25. Bergenstal RM1, Tamborlane WV, Ahmann A, et al STAR 3 Study Group. Sensor-augmented pump therapy for A1C reduction (START 3) Study: results from the 6 month continuation phase. Diabetes Care. 2011;34(11):2403-5. 26. Abraham MB1,2, Nicholas JA1,3, Smith GJ3 et al; PLGM Study Group. Reduction in Hypoglycemia With the Predictive Low-Glucose Management System: A Long-Term Randomized Controlled Trial in Adolescents With Type 1 Diabetes. Diabetes Care. 2017;Nov 30. pii: dc171604. doi: 10.2337/dc17- 1604. [Epub ahead of print] 27. Forlenza G, Raghinaru D, Cameron F, et al. Predictive hyperglycemia and hypoglycemia minimization: In-home double-blind randomized controlled evaluation in children and young adolescents. Pediatric Diabetes. 2017;1-9. 28. Breton M, Chernavvsky D, Forlenza G et al. Closed-loop control during intense prolonged outdoor exercise in adolescents with Type 1 diabetes: the artificial pancreas ski study. Diabetes Care. 2017:40(12):1644-50. 12. 29. Tauschmann M, Thabit H, Bally L, et al. Closed-loop insulin delivery in suboptimally controlled Type 1 diabetes: a multicentre 12-week randomised trial. Lancet. 2018:13:92. 30. OpenAPS.Outcomes. Downloaded 3/2/2021. 31. Standards of Medical Care in Diabetes-2021Diabetes Care. 2021;44 Suppl 1:S89 32. Danne T, Nimri R, Battelino R et al. International consensus of use of continuous glucose monitoring. Diabetes Care. 2017:40(12):1631-1640. 33. Chase P and Messner L. Understanding insulin pumps, continuous glucose monitors and the artificial pancreas (3rd ed). 2016. Children’s Diabetes Foundation at Denver, Colorado. 34. Wallia A, Umpierrez G, Rushakoff R et al. Consensus statement on inpatient use of continuous glucose monitoring. J. Diabetes Sci Technol. 2017:11(5);1036-1041. 35. Shapiro A. FDA approval of nonadjunctive use of continuous glucose monitors for insulin dosing: A potential risky decision. JAMA. 2017:318(16);1541-1542. 36. Rinker J, Dickinson J, Litchmanb M et al. Diabetes Educator. 2018:44(3):260-268.}