A guide for the pharmacist's role in insulin pump management during transitions of care

Abstract

In the United States, approximately 12% of the adult population has a diagnosis of diabetes mellitus (DM). Persons with DM are at a higher risk of microvascular and macrovascular complications, as well as hospitalizations, compared with the general population. Over the years, technology for diabetes management has evolved as approximately 350 000 patients are using insulin pump therapy to manage DM. Insulin pump therapy has been shown to improve glycemic control and lower the risk of safety events, such as hypoglycemia. Some studies have shown high compliance with an insulin pump policy among staff members during a hospitalization for a patient with an insulin pump. Other studies have shown improved glycemic control during hospitalization for patients who were managed on an insulin pump from an outpatient endocrinology clinic prior to admission. However, none of the studies involved pharmacy‐ or pharmacist‐led service for insulin pump management during transitions of care. Therefore, we defined the responsibilities of clinical pharmacists, in various roles, regarding insulin pump management in transitions of care. The purpose of this paper is to summarize current evidence for continuous subcutaneous insulin infusion (CSII) in transitions of care, including the use of insulin pumps in the hospital. Opportunities for a pharmacist's role in policies and procedures are also outlined, along with training of clinical pharmacists in this area of practice.

Home Insulin Pump Use in Hospitalized Children With Type 1 Diabetes

“…Team members may have evolving roles in caring for hospitalized children using home insulin pumps if more children begin to use home pumps. Hospitals may require some staff to obtain additional pump expertise as well …”

Diabetes technology: A primer highlighting the role of the pharmacist

“…Other studies detail the role of the pharmacist as part of the multidisciplinary team in managing insulin pumps during routine clinical care as well as transitions of care which may include activities such as policy development, patient monitoring, and postdischarge education. [13][14][15] Warshaw and colleagues describe how the pharmacist can recommend or guide other health care team members to utilize these devices and interpret the data to optimize outcomes with CIPs. 16 Future research and collaborative efforts should be pursued to strengthen the evidence involving the role of the pharmacist with diabetes technology.…”

“…These clinical improvements include improved patient self‐efficacy in managing diabetes and A1C reduction. Other studies detail the role of the pharmacist as part of the multidisciplinary team in managing insulin pumps during routine clinical care as well as transitions of care which may include activities such as policy development, patient monitoring, and postdischarge education 13‐15 . Warshaw and colleagues describe how the pharmacist can recommend or guide other health care team members to utilize these devices and interpret the data to optimize outcomes with CIPs 16 .…”