The Use of Insulin Pumps in Adults with Type 1 Diabetes – Experience from a Secondary Care Hospital in Kuwait

Aim: To explore the experiences of adults switching to insulin pumps, and to determine patients' views regarding the training/education they had received. Methods: A descriptive cross-sectional study was conducted using questionnaires containing both open-ended and closed questions. All patients with type 1 diabetes mellitus (T1DM) who were receiving continuous subcutaneous insulin infusion (CSII; i.e. insulin pump therapy) and attending adult diabetes outpatient clinics at Amiri Hospital, a secondary care hospital in Kuwait and pioneer in delivering insulin pump therapy service, were invited to participate (n=19). The questionnaires were distributed on one occasion whilst patients were waiting for their clinic appointment at the Hospital. Data management was undertaken using established qualitative and quantitative analytical procedures. Results:The majority of patients (n=18 out of 19; 95%) reported finding it easier to maintain glycemic control within their target range using CSII compared to their multiple daily injection (MDI) regimens. This was reflected in their mean glycated hemoglobin A1c levels (HbA1c) which fell from 9.53 ± 2.72% to 7.93 ± 1.51% (P< 0.05; 95% CI, 0.31-2.89), 6 months after CSII initiation. Patients also reported an overall increase in lifestyle flexibility and the ability to lead more ‘normal' lives at home (n=12; 63%) and college/work (n=16; 84%). CSII improved social interactions of some patients (n=9; 47%) and their capability to perform sports and physical activities (n=11; 58%) compared to injections. This was explained by the advantages the pumps had over injections: easier dose delivery, calculation, and correction; more accurate dosing; flexible eating pattern (time, type and amount of meals); and improved glycemic control. Negatives experiences related to wearing pumps and body image were also reported. Although education and training were received as part of insulin pump therapy programme at the Hospital, some patients thought that this was not enough. Accordingly, they highlighted the need for continuous update and training, with an emphasis on issues such as carbohydrate counting, insulin dose monitoring and dealing with pump malfunctions. Conclusion: Considering patients' experiences, using insulin pump was advantageous. Pump therapy programme at the Hospital can be further improved and used as a model for wider implementation in Kuwait.