In your opinion, would it be more cost-effective for insurance companies to provide their child clients who have type 1 diabetes with insulin pumps versus more traditional insulin therapies? Please also consider in your response all of the possible long-term effects of type 1 diabetes.

Almost all insurance companies pay for insulin pumps now so it is hard to know the reason for your question. They only require some standard and (usually) reasonable requests: documentation of labile blood glucose results on multiple insulin injections, reasonable compliance and followup, documented hemoglobin A1c levels, documentation of excessive or unpredictable hypoglycemia, etc. Our office has never had anybody turned down for an insulin pump when we answer such straightforward questions in more than 25 years! Occasionally, one needs to request a followup reassessment if an initial request is denied and when done by an endocrinology/diabetology expert reviewer, the approval always follows.

There is no good scientific study that shows that pumps are always superior to injections. Many people can get excellent glucose control with multiple injection therapy coupled with frequent monitoring, carbohydrate counting, exercise adjustment, etc. So, each person must be evaluated as an individual for optimizing therapy for each circumstance. With this in mind, young children, school-age children, adolescents, young adults, adults, and the elderly can all be candidates for insulin pump therapy with appropriate evaluation, education and support.

SB