Abstract
INTRODUCTION: There is currently a limited understanding of the process of initiating standard insulin pump therapy (IPT) and how this differs with pump type. A time-and-motion study was conducted in Germany and the United Kingdom (UK) to evaluate the time required for initiation with a tubeless insulin pump (a pod) versus other tubed pumps. METHODS: The time taken to initiate patients onto tubeless IPT and tubed IPT (excluding automated insulin delivery systems, AID) was self-recorded by diabetes specialist nurses using a web-based tool. Pump users were adults with and without prior experience of IPT, and initiations were conducted face-to-face and remote. RESULTS: In 276 recorded initiations (112 tubeless, 164 tubed, 89% type 1 diabetes), the mean time for initiating tubeless IPT was 13 min shorter compared with tubed IPT, 118 min [standard deviation (SD): 94] vs. 131 min [SD: 109]; p < 0.001. There was a particular benefit in people transferring from multiple daily injections (MDI) and for all initiations in a face-to-face setting. People transferring from MDI in a face-to-face setting had the highest time saving with tubeless IPT (24 min per nurse per initiation, p = 0.001), and this was also substantial for people in the face-to-face setting from both MDI and prior IPT (15 min per nurse per initiation, p = 0.002). According to survey responses, nurses reported initiations on tubeless IPT to be as effective as on tubed IPT despite taking less time. CONCLUSIONS: This novel time-and-motion study identified significant time reductions for initiating tubeless IPT vs. tubed IPT. Applying these time savings across pump services could increase efficiencies for initiating IPT and reduce workloads. Further time-and-motion studies for IPT and AID initiations are needed.