Recipient organisationUniversity of SheffieldSource-published name: The University of Sheffield
Funding£1.8M
PeriodJun 2011 — Jan 2016
In plain English
AI plain-English summary
A large clinical trial is testing whether insulin pumps actually improve blood sugar control more than injections, when both groups receive the same intensive training in adjusting their insulin doses. The problem is that insulin pumps cost the NHS significantly more than injections, yet previous studies have not separated the effect of the pump technology itself from the structured education that typically accompanies it. Without this distinction, it is impossible to know whether the extra expense is justified. The REPOSE trial directly addresses this gap by giving 280 adults with Type 1 diabetes the same one-week education course, then randomly assigning them to either pump therapy or multiple daily injections. If the trial shows that pumps provide clear benefits—better glucose control, fewer dangerous hypos, or improved quality of life—the Department of Health can use the results to decide which patients are most likely to benefit. This would allow NHS commissioning bodies to target pump funding toward those who need it most, rather than offering it broadly at high cost. If pumps show no added benefit over injections plus good education, the NHS could avoid unnecessary spending without compromising patient outcomes.
View original technical description
In Type 1 diabetes, the aim of insulin therapy is to keep blood glucose close to normal to prevent longterm complications without severe hypoglycaemia (low blood sugar) Insulin is generally administered by multiple injections with the dose adjusted according to eating and exercise. Insulin can now also be administered using a pump device filled with insulin that can continuously supply both the insulin needed for basal metabolism throughout the day, and to cover meals. The use of pumps is expensive compared to injections, but the potential advantages include better glucose control, reduced risk of hypoglycaemia and a more flexible lifestyle. Although previous trials have shown some benefit, the improvements have often been modest and it is unclear whether these benefits are in part due to the structured education that accompanies pump training. There have been no trials in adults that have compared pump treatment with injections where the same structured education in insulin adjustment has been given, so the added benefit of the pump technology is still unclear. There is a need to establish this, and identify patients who benefit the most. The Department of Health could then calculate the proportion of adults that would benefit from pump therapy, and guide the commissioning bodies that are expected to provide funding. The aim of the trial is therefore to establish the additional benefit of pump therapy over high quality structured education including quality of life and cost effectiveness. 280 participants will be recruited from seven UK centres and randomised to a one week education course with multiple injection or pump treatment. For each participant biochemical, quantitative and qualitative psychosocial measures and health economics will be assessed at baseline (before the course), 6 months (after the course has ended), 12 months and 24 months. .
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