Most people with diabetes use Insulin Pumps, Right? Wrong!

Most people in the Irish Diabetes Online Community seem to be using insulin pumps, and if I didn’t know better, I might think this is the norm in the Irish diabetes population and even the world. But the truth is that most people with type 1 diabetes in Ireland use insulin pens, not pumps. How do I know this?

Well, there are no technology audits on diabetes in Ireland yet. However, the important work of Kate Gajewska 2021 gave us some information on access to pumps in 2016, which reported that insulin pump uptake was:

10% of Type 1 Diabetes in Ireland,
35% of children with type 1 diabetes,
7% of adults with type 1 diabetes.

Thriveabetes recorded an interview with Kate in 2020 when her research was published, which you can watch here.

During the pandemic, many more people with diabetes joined the online community, and it seemed like pump uptake had been increasing quite a bit since then. So, I got curious if access to insulin pumps has improved in the seven years since 2016 and with the help of my fabulous local TD in Clare, I used my usual tool of parliamentary questions to find out.

This week's post provides a short summary of the information revealed through collating the responses. Those who are curious can read the full document here with supporting information.

Why are Insulin Pumps so Important as a treatment Choice?

According to research recently published on Best practice guide for hybrid closed-loop therapy, approximately one-third of people with type 1 diabetes achieve an HbA1c of less than 58 mmol/mol (7%), and the availability of Hybrid closed-loop insulin pumps has proved very effective in improving HbA1c as well as reducing the burden and distress of living with the condition (Griffin et al. 2023).

How many people use insulin pumps in Ireland?

According to the parliamentary question responses, the total number of people prescribed insulin pumps and currently using them in 2022 is 4,438. This represents 15% of the estimated type 1 diabetes population and an increase of 5% in seven years.

The PQs asked for details on how many people are using pumps in the 0-17 years age group and how many are 18 years and older, but this was not provided for two of the four brands, and the two pump brands who did, provided the age categories of Under 21 and Over 21 years. So, we don’t know how many children are using pumps or how many are adults. However, the government approved funding in budget 2023 for the National Office of Clinical Audit NOCA to launch a paediatric diabetes audit, including finding out how many children are using pumps. This would provide excellent data.

Surprising Discoveries

The most surprising discoveries from the information included what pump brand was used the most and some of the regional differences in access to pumps. Another interesting fact is that there isn’t a centrally located national database that contains this information; Insulin Pump approval is done at a local level.

Different Pump Brands

Most people (76%) are using the Medtronic pumps (640G and 780G), which isn’t a surprise, really, as it's the pump company that has been in Ireland the longest. The surprise was that the second most used pump was the Tandem T:Slim, at 13%, which has only been available in Ireland since February 2022 - not even an entire year. The YspoPump was the least used one at 4% of pump users. This was another surprise, as it’s been available since 2018.

The breakdown of uptake in insulin pumps between Medtronic, Roche, Tandem and YpsoPump

Total number of People prescribed insulin pumps	4,438
The breakdown between the Pump Companies:
The total number using Medtronic insulin pumps	3,395	76%
The total number using Roche insulin pumps	261	6%
The total number using Tandem insulin pumps	597	13%
The total number using YpsoPump insulin pumps	185	4%

How many clinics are offering insulin pumps as a treatment option?

In addition to finding out how many people use pumps, I also decided to find out how many diabetes clinics offer pumps as a treatment option. Twenty-five diabetes clinics offer insulin pumps as a treatment option: 13 are children's diabetes clinics, and 12 are Adult Diabetes Centres.

The Average Number of New Pump Starts per year

In the last four years, the average number of new pump starts initiated in people not previously using a pump was 303. The pandemic slowed overall pump uptake between 2020 and 2021, but in 2022, the number of new pump starts in children was higher than pre-covid. It would seem that the adult pump starts are still catching up to pre-COVID levels in most places, but this could be because some of the hospitals in the Ireland East hospitals group did not provide complete information for 2022.

The highest average annual number of new pump starts is in the Saolta hospitals groups. The clinics providing pumps in this group are Galway University Hospital, Sligo and the paediatric diabetes clinic in Portiuncula, Ballinasloe.
Letterkenny UH does not initiate pump starts in their clinic; they refer their pump candidates to Sligo or CHI hospitals.
The CHI hospitals of Temple Street, Crumlin, and CHI Tallaght are also consistently have the highest average number of new pump starts.

Another big surprise was the very low number of new pump starts initiated in the Adult diabetes clinic at Cork University Hospital over the four years between 2019 and 2022. Yet they had a very high number of new pump starts in children in 2022 compared to their pre-COVID number.

The graph below shows the total number of new pump starts done in each hospitals group from 2019 to 2022. There are additional graphs in the full report looking at the new starts done in the paediatric and adult populations, which can be viewed here.

So, how are we doing?

Well, this information is incomplete despite the best efforts of this individual, so it’s difficult to draw any definitive conclusions. However, it does raise some more questions, such as:

How many people get their pumps through private clinics or endocrinologists?
How can we get better information about the population, especially age profiles and diabetes types? Should we prioritise creating a National centrally located database recording this information?
Do the barriers identified by Kate Gajewska in 2016 still remain, or are there new barriers to insulin pumps in 2023? My gut says yes, even more so, given the resource drain from staffing the Chronic Disease Hubs in Primary care.
Would we benefit from an education campaign on the benefits of pumps for people with diabetes?

What is conclusive is that Ireland is not recording this information well. If we are to increase the uptake of insulin pumps, especially since the introduction of the revolutionary closed-loop systems, then this is an area we need to know more about.

If you want to learn more about insulin pumps, such as how they work, the following webpages on Thriveabetes are a good resource.

Useful resources about insulin pumps: