Introduction: The management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes. Method: Data were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the Pump’. Children’s data is presented separately within a journal article format. Discussion: Findings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control. Conclusion: This research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.

To date there have been no complete reports of the nutrient intakes of persons with Type I diabetes mellitus who use continuous subcutaneous insulin infusion (CSII) pumps. The purpose of this study was to describe the sample population and to determine the nutrient intake of adult Type I diabetics from the Salt Lake City, Utah area, who use CSII. Seven male and 15 female CSII users, ages 25 to 53, completed a questionnaire and a three-day diet record as instructed. Diet records were coded and household measurements of foods were converted to gram weights for computerized nutrient analysis. Nutrient intake is reported as group mean and standard deviation for sex and age. The average duration of diabetes was 17 years. The average length of CSII use was l.6 years. Review of the medical charts revealed that weight gain since beginning CSII averaged 5.5 pounds irrespective of the duration of pump use. The dietary intake of protein, calcium, phosphorus, vitamin A, thiamin, riboflavin, niacin, vitamin B12 , and ascorbic acid met or exceeded the Recommended Dietary Allowances (RDA) for both men and women. For males, mean nutrient intakes were below the RDA for zinc (82.7%), folate (82.2%), and vitamin 86 (69.0%). For females, intakes were also below the RDA for zinc (64.0%), folate (58.3%), and vitamin 86 (69.0%), as well as for iron (58.5%) and magnesium (88.0%). The average percent of kilocalories from protein, carbohydrate and fat, (approximately 17%, 43%, and 40%) was similar for both the males and females. The day-to-day variation in carbohydrate intake for both sexes was not significantly different. Intake of added sugar in the diet was 6.6% and 5.8% of total kilocalories (14.8% and 13.9% of the carbohydrate kilocalories) for males and females, respectively. In conclusion, dietary intake for this small group of CSII users was adequate in most nutrients . Of concern is the apparent inadequate intakes of zinc, folate, vitamin s6 and iron for women, as compared to the current RDA standards. The distribution of kilocalories from protein, carbohydrate and fat approaches the 1979 recommendations by the American Diabetes Association. Weight gain may be a problem for some CSII pump users, and should be monitored.

OBJECTIVE: To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. RESEARCH DESIGN AND METHODS: This study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services. RESULTS: Twenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m(2) pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001). CONCLUSIONS: Pharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician-pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

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<p>Since the late 1970s, biomedical researchers have heavily invested in the development of portable insulin pumps that allow people with Type 1 Diabetes (T1D) to carry several days-worth of insulin to be injected on an as-needed basis. That means fewer needles and syringes, making regular insulin injections less time consuming and troublesome. As insulin pump use has become more widespread over the past twenty years among people with T1D, the social and cultural effects of using these medical devices on their everyday experiences have become both increasingly apparent for individuals yet consistently absent from social and cultural studies of the disease.</p><p><br></p><p>In this dissertation, I explore the technological, medical, and cultural networks of insulin pump treatment to identify the role(s) these biomedicalized treatment acts play in the structuring of people, their bodies, and the cultural values constructed around various medical technologies. As I will show, insulin pump treatment alters people’s bodies and identities as devices become integrated as co-productive actors within patient-users’ biological and social systems. By analyzing personal interviews and digital media produced by people with T1D alongside archival materials, this study identifies compulsory patterns in the practices, structures, and narratives related to insulin pump use to center chapters around the productive (and sometimes stifling) relationship between people, bodies, technologies, and American culture.</p><p><br></p><p>By analyzing the layered and intersecting sites of insulin pump treatment together, this project reveals how medical technologies, health identities, bodies, and cultures are co-constructed and co-defined in ways that bind them together—mutually constitutive, medically compelled, cultural and social. New bodies and new systems, I argue, come with new (in)visibilities, and while this new technologically-produced legibility of the body provides unprecedented management of the symptoms and side-effects of the disease, it also brings with it unforeseen social consequences that require changes to people’s everyday lives and practices. </p>