DIABETES. Diabetes Name of the student: Name of the Uni

Running head: DIABETES
Diabetes
Name of the student:
Name of the University:
Author’s note

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CW1- A critical discussion on the role of insulin pumps in the management of diabetes
Introduction:
Diabetes is a metabolic disorder characterized by presence of symptoms like
hyperglycemia, insulin resistance and relative insulin deficiency (Zaccardi et al. 2016). Although
type 2 diabetes is most commonly diagnosed in people, however management of type 1 diabetes
is also challenging because of the need to maintain insulin deficiency. Another issue is that type
1 diabetes can be seen at any age. The diagnosis of the condition presents additional challenges
for elderly people because the process of ageing may significantly influence diabetes
management. For example, adults with type 1 diabetes (T1D) are most likely to suffer from
malnutrition because of impaired sense of taste and self-management becomes difficult for them
because of impaired vision (Kilvert and Fox 2015). In contrast, the incidence of T1D in children
below 6 years is rising and inability to control T1D in children contributes to increase in parental
stress (Streisand and Monaghan 2014). Insulin therapy is the cornerstone for T1D management
and the main purpose of this report is to critically discuss about the role of insulin pumps in the
management of T1D and review current evidence based principles to effectively use insulin
pumps for the treatment of T1D. This is based on the case study mentioned in appendix.
Critical discussion on the role of insulin pumps in diabetes treatment:
Significance of insulin pump therapy
Insulin pump therapy is one of the new methods for delivering insulin to people with
T1D. Although insulin pumps are available since the 1980s, modern pumps have come up that
have eliminated barriers related to pump failure. Insulin pump is mainly a small and portable
insulin delivery device which delivers short acting insulin continuously via subcutaneous site.

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Fast acting insulin analogue is the most recommended insulin pumps and the main advantage of
this therapy is that it mimics physiological insulin secretion by making insulin available 24 hours
a day. Another advantage of insulin pump is that it gives diabetic patient the chance to lead a
more flexible lifestyle instead of restricting their food cravings (Shulman et al. 2016). Maahs,
Horton and Chase (2010) suggested that insulin pump use in children is associated with
enhanced blood sugar control, easy adjustment of insulin dose with travel and better control of
port-meal blood sugar values. Despite the advantage of insulin pumps as a rapid acting insulin
analogue, the success of the technology is dependent on skills and knowledge of users too. Those
using insulin pumps need to frequently monitor blood glucose level and pay attention to
mechanical and injection site issues too (Shulman et al. 2016). Hence, reviewing the evidence
based for mitigating these form of challenges for pump users is important.
The importance of insulin pump on diabetes management is also understood from its
impact on quality of life parameters. Ghazanfar et al. (2016) revealed that the use of insulin
pump significantly improves quality of life of diabetic patients. The study used case-control
study approach to investigate about the impact of insulin pumps on patient using insulin pump
and the control group not using the pump. Patients who are diagnosed with diabetes often suffer
from poor self-esteem because of diet restrictions and poor physical health (Luyckx et al. 2016).
However, the study revealed increase in self-esteem, decrease in stress and better mood for
patients using insulin pumps because of flexibility in meal eating time. The use of insulin pumps
increased meal eating timing. Other options for patients included use of multiple insulin
injections and such patients need to follow a strict schedule for their meal time. This has impact
on social activity of patients too. However, the use of insulin pumps has been associated with
greater flexibility in life for diabetic patient, with regard to meal time flexibility and socialization

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(Ghazanfar et al. 2016). Hence, insulin pump can act as new source of hope for people who are
troubled by the diagnosis of diabetes and its associated changes in their social life.
Evidence for benefits and risk associated with insulin pump use
Based on the case study, considering the potential of insulin pump in the management of
patients with diabetes is important as it will help to understand positive benefits of the
technology and any potential issues related to its use for certain group too. Although insulin can
be delivered to T1D patients by multiple means, however there are many research evidences
which show why insulin pump is superior to other insulin delivery methods. A qualitative
research by Alsairafi et al. (2018) investigating about the patient’s experience related to insulin
pump use revealed several advantages of insulin pumps in relation to glycaemic control, quality
of life and adherence to dosage. Cross-sectional semi-structured interview method was used to
explore patient’s view about the use of insulin pumps. The review of participant’s response
revealed that use of insulin pump was associated with improved blood glucose level and there
were fewer hyoglycaemic episodes for patients on insulin pumps compared to MDI (multiple
daily injections). Another most positive outcome of insulin pump use was that it was associated
with improved adherence to dose administration. This evidence suggests the advantage and
potential of insulin pumps for patients with diabetes. Such positive outcomes have been possible
because of technological advancements of insulin pumps over other delivery methods. Automatic
dose calculation is the feature in the device that has reduced management challenges for people
with diabetes.
Another research by Grose et al. (2018) used qualitative approach to explore experience
of people living with T1D and using an insulin pump. The main difference in life for participant

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was that insulin pump has given them better flexibility. However, there were also certain patient
groups who reported difficulty and newer restrictions on their lifestyle because of insulin pump
therapy. Some participants reported difficulties with concealing the pump when wearing certain
clothing and others found the device to be obtrusive while doing exercise. Despite this, the
broader message was that participants expressed improved sense of well-being after initiating the
CSII therapy.
Consideration of evidence based principles to resolve issue related to insulin pump use
To consider application of the evidence to initiate insulin pump use in the case study,
there is a need to consider evidence based principles before it can be applied in the case study
situation. Evidence based practice is a problem-based approach where clinical decision making is
informed by research evidence. In case of any clinical encounter which is associated confusion,
health care practitioners should take the approach to identify best research evidence and take into
account patient’s beliefs and other circumstances that could affect the application of research
evidence (LoBiondo-Wood and Haber 2017). Hence, to effectively use insulin pumps to achieve
positive outcome for patients with T1D, there is a need to review challenges both for patient and
staffs and identify possible solutions to eliminate these barriers.
The study by Grose et al. (2018) revealed that despite advantage of insulin pump therapy,
there are many flaws that limit use of insulin pumps for all types of patient. However, the
evidence is not considered reliable because of selection bias. The study was done only with T1D
patients who were pump users. There is a need to evaluate studies where staffs and other patient
groups have also reported the same difficulty. This approach would help to resolve the barriers
identified and find appropriate solution to promote use of insulin pumps for all T1D patients

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without any difficulty. The critical appraisal of possible risk associated with insulin pumps and
the review of safety standards would help to understand the application of the technology in the
case study. The research study by Heinemann et al.
(2015) is significant in this regard as it focused on investigating about possible errors during the
use of insulin pumps. The study indicates that by the use of insulin pumps, the users are most
likely to be exposed to fatal hazards because of pump failure, insulin infusion set blockage, user
related errors, infusion site issues and insulin instability issues. To appropriately respond to
adverse events reported after the use of insulin pumps, there is a need to take more standardized
and transparent approach to identify and report adverse events. This evidence suggest the need
for educating clients regarding safe use of insulin pumps too before it can be readily used by
clients in their daily life (Heinemann et al. 2015).
Possible adverse events caused due to use of insulin pumps among diabetic patients
Despite availability of enough evidence to prove the benefits of insulin pumps for
treatment of diabetes, presence of certain challenges in the use of insulin pump also suggest the
need for evidence based guidelines to achieve optimal outcome for patient. Before fully
implementing the insulin pump therapy for particular patient, the first step that is needed as per
evidence based practice principle is to critically appraise evidence related to the adverse events
related to the use of pumps. This would help to identify adjustments needed to achieve full
benefits of the technology for target patient or patient group. A literature review by Ross et al.
(2015) gave details on insulin pumps related adverse events in adults and children. The study
revealed that that at least 40-45% of pediatric and adolescent patients using modern generation
insulin pumps experience one or more adverse events per year. The most common cause of
errors included pump failure and infusion set failures. The number of pump replacement is also

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an indication of the significance of the pump malfunction issues. Other forms of error include
occlusion, catheter associated errors, cutaneous complications, infection. Some of the acute
metabolic adverse events include diabetic ketoacidosis and hypoglycemia. This form of thorough
understanding about adverse events in the clinical setting might help to conduct appropriate pre
and post marketing surveillance for adverse events. The review of adverse events also suggests
that ongoing education and support for patient is paramount to ensure safe use of device. This
step would help to critically review patient factor as well as other factors that might affect
utilization of the technology.
The significance of the evidence by Ross et al. (2016) is that it focused not only on
evaluation of potential adverse event only in one pediatric center, but also on insulin pump
associated adverse events in New Zealand adults and children with T1D. The examination of
participant’s response to pump-related issues revealed hypoglycemia and pump malfunction was
the reason behind various adverse events. Pump malfunction mainly occurred because of
physical damage, battery related issue, insulin leakage, missing hardware parts and water
damage. Participants in the study mainly sought assistance from the pump manufacturer’s
customer care line and the hospital diabetes service. The strength of the study is that
heterogeneous population group has been analyzed to understand types of adverse events
occurring due to insulin pump use. Furthermore, multi-center study has enhanced the credibility
of the research findings. The study gives the implication that like all technology, insulin pumps
are also infallible and patient education plays a vital role in promoting successful and safe use of
pumps. Hence, the experience of the client in the case study can be enhanced if education and
training related to pump use is given in an effective manner.

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Providing support to client with T1D related to safe insulin pump use
As per the evidence based practice principle, best available evidence should be applied
considering the contextual factor of patients. In the context of case study, patient can be
supported to effectively use the insulin pump by the utilization of best evidence related to safety
of insulin pumps. The success of initiating insulin pump therapy would depend on educating the
client regarding site preparation, basal bolus insulin therapy, glucagon administration and
prevention and treatment of hypoglycemia. Certified insulin pump users like registered nurse,
dietitians and pharmacists can engage in providing diabetes education. The initial education
session can focus on providing education related to basics of pump operation and then it can
proceed with in-depth education on management of infusion site issues and additional strategies
related to pump success (Reece and Williams 2014).
As per the evidence based practice principles, the successful integration of evidence
based practice is dependent on identifying areas of concern, putting research into action and
sharing the knowledge (Straus et al. 2018). The review of adverse events related to insulin pump
use suggests the need to put research into action by identifying possible solution to reduce
adverse events. The review of studies by Ross et al. (2016) and Ross et al. (2015) gives the
implication to use education as a means to pass on and share new knowledge with patients. This
would help to address clinical problem and implement appropriate quality improvement
initiatives too. The above discussion suggested possible steps that can be taken to provide
education to patients with T1D regarding safe insulin pump use. However, another thing that
needs to be considered to ensure patients are confident in using insulin pumps includes
identifying personal barriers faced by patients and developing solutions to reduce those barriers.

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Tanenbaum et al. (2017) investigated about the barrier to uptake of diabetes device use in
adults with T1D. The significance of research in this area is that it can pave way for modifying
the design of intervention to increase the uptake of the device. Tanenbaum et al. (2017)
categorized barriers into modifiable and non-modifiable factors. Although non-modifiable
factors like cost and health insurance are addressed by policy makers, other factors like patient’s
perception or attitude towards technology use can be modified by health care professionals like
nurse and patient. The investigation regarding the reasons for discontinuing device use revealed
that cost of device as the most common barrier followed by hassle of wearing devices and not
liking the device on one’s body. Another common link was barrier to use device was higher in
patients who were younger. Hence, this evidence can be put into action by considering actions
that can be taken to eliminate physical barriers to increase device uptake in relation to the case
study.
Many innovative approaches have been identified to overcome barrier related to device
use for the case study. Although physical barrier related to insulin pump use cannot be addressed
by considering design size, however psychosocial intervention can be beneficial in addressing
user’s ability to cope with physical barriers. For example, they can be taught problem solving
technique to manage physical barriers associated with device use. Patients can be educated
regarding the significance of the technology in response to other devices and they may be
motivated to use the device by showing how far insulin pump use can enhance the quality of life.
This would lead to change in attitude towards use of device. Furthermore, adherence to device
use can be achieved by better communication between device experts and patient so that ongoing
support can be used to provide ongoing support for users and reduce the likelihood of device
discontinuation (Alsairafi et al. 2018).

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Conclusion:
To conclude, the critical discussion on the role of insulin pump for management of T1D
indicates insulin pumps as an effective device to resolve the issue of hyperglycemia and
managing insulin level for T1D patient. Another advantage of this device is that it provides
lifestyle flexibility to users and improves quality of life of patient. However as certain barriers to
the use of insulin pump has been identify, the report used the evidence based practice principles
to identify best evidence, interpret them and find possible solutions to address the clinical issue
in the case study.

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CW2- Short answers
1. Three symptoms of diabetes include frequent urination, feeling of thirst and hunger and
extreme fatigue.
2. 3 social determinants influencing self-management of type II diabetes includes education
level, employment and poverty.
3. Primary prevention in diabetes involves the prevention of diabetes by reducing or
eliminating risk of diabetes among target population. It is concerned with interventions
that prevent the onset of diabetes in people. The secondary prevention of diabetes
involves reducing the impact or severity of the condition in people already diagnosed
with diabetes.
4. The first resource that can be used for management of diabetes includes the NICE
guidelines for management of type 2 diabetes in adults (NICE 2017). The advantage of
using NICE guideline is that it is a reliable source that provides structured education on
individualized care and managing complications in patient. Another resource that can be
utilized includes the evidence based nutrition guidelines for prevention of diabetes
developed by Diabetes UK (Diabetes UK. 2018). The significance of this resource is that
each informed is backed up by evidence based evidences too.
5. a) Signs and symptoms of gestational diabetes: Frequent urination, unusual thirst and
fatigue
b) Risk factors: Advancing age, obesity, hypertension and excessive central body fat
deposition (Pons et al. 2015).

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c) Good management practice: Implementing self-blood glucose monitoring education and
medical nutrition therapy is considered as effective management practice for gestations
diabetes (Meloncelli et al. 2018).
6. Secondary diabetes may be caused by cystic fibrosis, hormonal syndrome that interferes
with insulin secretion and hormonal syndrome that lead to peripheral insulin resistance.
7. a. After eating a food, blood sugar level increases. Specialized cells respond to this signal
by releasing insulin hormone. This results in decrease in blood sugar level leading to a
negative feedback mechanism.
b. Glucagon plays a role in initiating negative feedback mechanism in low blood sugar and
increasing blood sugar level. During sleep or between meals, blood glucose levels are low
and glucagon is released to increase endogenous blood glucose level (Röder et al. 2016).
8. Pancreas is mainly involved in maintaining the blood glucose level and the primary
hormones involved in blood glucose regulation includes the insulin, glucagon, gastrin and
somatostatin hormone. Pancreas plays a role in producing hormones and maintaining blood
sugar balance (Röder et al. 2016).
9. Difference between prevalence and incidence is that incidence is the rate of newly
diagnosed cases of disease within a specific time period, whereas prevalence is the actual
number of cases living with the disease during a period of time.
10. The term mortality is used in epidemiology mainly to indicate number of deaths
occurring due to a disease, whereas morbidity refers to the state of being ill with several
health issues.

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End of unit 1 activity:
Situation related to type 2 diabetes in the locality:
The number of people diagnosed with diabetes is increasing in Greater Manchester. The
current situation is understood from the fact that there are about 1, 60, 000 people living with
diabetes in Greater Manchester. Majority of this population group have type 2 diabetes compared
to Type 1 diabetes. It is responsible for 1, 000 premature deaths each year in the locality too
(NHS 2018).
Comparison with nation:
Compared to greater Manchester, the 4.6 million people are living with diabetes in the
UK. 12.3 million people are at increased risk of type 2 diabetes thus indicating that risk is higher
both in local as well as national statistics (Diabetes UK 2018). When looking at international or
global prevalence of type diabetes, it has been found that diabetes is rapidly increasing in middle
and low income countries. An estimated 1.6 million deaths in the world were caused by diabetes
in 2016 (World Health Organization (WHO) 2018).
Strategy needed to manage diabetes:
The strategy that is needed to control type 2 diabetes in the locality includes promoting
lifestyle changes in people to achieve glycaemic control. Lifestyle intervention is considered
important because of its ability to address risk factors like sedentary lifestyle and poor physical
activity. Research evidence show that type 2 diabetes is a lifestyle disease and it can be
prevented by intensive lifestyle interventions leading to improvement in dietary habits and level
of physical activity. Lifestyle interventions have long-term benefits as significant improvement

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in diabetes development has been seen over the past 15 years (Diabetes Prevention Program
Research Group, 2015).
End of unit 2 activity:
Two research article by REPOSE Study Group (2017) and Christie et al. (2016) are high
quality literatures for the assessment, treatment and management of type 1 diabetes. REPOSE
Study Group (2017) mainly used clustered randomized trial to comment on the relative
effectiveness insulin pump treatment for type 1 diabetes and Christie et al. (2016) used cluster
randomized controlled trial to study the effectiveness of a structured educational intervention in
children with poorly controlled type 1 diabetes. The quality of the evidence using the GRADE
tools is as follows:
Author Risk of bias Imprecision Inconsistency Indirectness Publication
bias
Christie et al.
(2016)
No low No No No
REPOSE
Study Group
(2017)
No Low yes yes yes
Summary of each paper:
Christie et al. (2016) used structured education programme that incorporated motivation
approach to promote behavior change in people with diabetes. Each module focused on different
aspects of diabetes and children and young people with T1D were taken in the study. The

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assessment of subjects was mainly done by the analysis of primary outcome variable of HbA1c
value and the secondary outcome included investigation on emotional and social functioning.
The intervention was ineffective because of lack of administrative support. Focusing on specific
needs of children and young people with T1D is necessary to achieve positive outcome.
REPOSE Study Group (2017) investigated on the relative effectiveness of insulin pump
treatment over multiple daily injections for treatment of T1D. The study was done in secondary
care centres in England and Scotland and the participants included adults with T1D willing to
take insulin treatment. The main intervention included use of insulin pumps and the outcome
included reduction in HbA1c value and secondary outcomes like insulin dose, hyperglycemia
and body weight. The study finding revealed that pump users had achieved higher level of
gylcaemic control compared to other group.
End of unit 3 activity:
Full reference for the document: Yorke, E. and Atiase, Y., 2018. Impact of structured education
on glucose control and hypoglycaemia in Type-2 diabetes: a systematic review of randomized
controlled trials. Ghana medical journal, 52(1), pp.41-60.
Summary of the content: The study by Yorke and Atiase (2018) aimed to assess the impact of
structured education on glucose control and hypoglycaemia in type 2 diabetes. The systematic
review of research papers revealed that majority of papers reported positive effect of the
intervention on glycaemic control compared to control group. Hence, this evidence can be
incorporated in routine care

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Credibility of the source: The credibility of the evidence is high as it is a systematic review of
randomized controlled trial and systematic reviews comes in the top most position in the
hierarchy of scientific evidence.
Specific material that might be useful: The specific information that can be useful is that it
revealed the advantage of group based education over individual education. This included
increase cost-effectiveness, increased contact time and opportunity of sharing and learning from
experience. This would help to implement group based education session in target setting (Yorke
and Atiase 2018).
End of unit 4 activity:
1. Gestational diabetes- The NICE guideline provided detail on management of gestation
diabetes from preconception to the postnatal period. The important aspects of the
guidelines are as follows:
 Key priorities- The significance of the key priorities is that it gave appropriate advice to
women with women regarding achieving capillary plasma glucose target.
 Time table for appointment- significance of the guideline is that it gave clear instructions
related to the stage during which they should contact diabetes and antenatal clinic.
 Safety of medicines for diabetes before and during pregnancy- Information in this area
helped to understand the medications and alternative therapy needed for women with
gestational diabetes (NICE Guideline 2015).
2. Diabetes as a result of pancreatitis or pancreatectomy: The significance of this paper
is that it gives a brief idea about pancreatogenic diabetes and extends knowledge related
to the pathophysiology as well as the management of pancreatectomy. The article

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mentions gylcemic control, lifestyle modifications, nutrition and total pancreatectomy
with islet autotransplantation as some of the management steps to deal with the condition.
The significance of the evidence is that it gives the notion that optimal gylcaemic control
is the key to reducing risk of chronic complications and improving quality of life of
people with pancreatogenic diabetes (Makuc, J., 2016).

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References:
Alsairafi, Z.K., Smith, F.J., Taylor, K.M.G., Alsaleh, F. and Alattar, A.T., 2018. A qualitative
study exploring patients’ experiences regarding insulin pump use. Saudi pharmaceutical
journal, 26(4), pp.487-495.
Christie, D., Thompson, R., Sawtell, M., Allen, E., Cairns, J., Smith, F., Jamieson, E.,
Hargreaves, K., Ingold, A., Brooks, L. and Wiggins, M., 2016. Effectiveness of a structured
educational intervention using psychological delivery methods in children and adolescents with
poorly controlled type 1 diabetes: a cluster-randomized controlled trial of the CASCADE
intervention. BMJ Open Diabetes Research and Care, 4(1), p.e000165.
Diabetes Prevention Program Research Group, 2015. Long-term effects of lifestyle intervention
or metformin on diabetes development and microvascular complications over 15-year follow-up:
the Diabetes Prevention Program Outcomes Study. The lancet Diabetes & endocrinology, 3(11),
pp.866-875.
Diabetes UK 2018. Number of people living with diabetes doubles in twenty years. Retrieved
from: https://www.diabetes.org.uk/about_us/news/diabetes-prevalence-statistics
Diabetes UK. 2018. Evidence-based nutrition guidelines for the prevention and management of
diabetes March 2018. Retrieved from: https://diabetes-resources-production.s3.eu-west-
1.amazonaws.com/resources-s3/2018-03/1373_Nutrition%20guidelines_0.pdf
Ghazanfar, H., Rizvi, S.W., Khurram, A., Orooj, F. and Qaiser, I., 2016. Impact of insulin pump
on quality of life of diabetic patients. Indian journal of endocrinology and metabolism, 20(4),
p.506.

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Grose, D.N., O'Brien, C.L., Bongetti, E.K., Corcoran, H.M., Loh, M.M., Ward, G.M. and Castle,
D.J., 2018. Living with type 1 diabetes and an insulin pump: a qualitative insight. Practical
Diabetes, 35(5), pp.171-177a.
Heinemann, L., Fleming, G.A., Petrie, J.R., Holl, R.W., Bergenstal, R.M. and Peters, A.L., 2015.
Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event
reporting and research needs. A joint statement of the European Association for the Study of
Diabetes and the American Diabetes Association Diabetes Technology Working
Group. Diabetologia, 58(5), pp.862-870.
Kilvert, A. and Fox, C., 2015. The challenges of type 1 diabetes in older people. Practical
Diabetes, 32(5), pp.175-179.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing research: Methods and critical appraisal for
evidence-based practice. Elsevier Health Sciences.
Luyckx, K., Rassart, J., Aujoulat, I., Goubert, L. and Weets, I., 2016. Self-esteem and illness
self-concept in emerging adults with type 1 diabetes: long-term associations with problem areas
in diabetes. Journal of health psychology, 21(4), pp.540-549.
Maahs, D.M., Horton, L.A. and Chase, H.P., 2010. The use of insulin pumps in youth with type
1 diabetes. Diabetes technology & therapeutics, 12(S1), pp.S-59.
Makuc, J., 2016. Management of pancreatogenic diabetes: challenges and solutions. Diabetes,
metabolic syndrome and obesity: targets and therapy, 9, p.311.

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Meloncelli, N., Barnett, A., Pelly, F. and de Jersey, S., 2018. Diagnosis and management
practices for gestational diabetes mellitus in Australia: Cross‐sectional survey of the
multidisciplinary team. Australian and New Zealand Journal of Obstetrics and Gynaecology.
NHS 2018. Tackling diabetes together. Retrieved from:
https://www.gmhsc.org.uk/wp-content/uploads/2018/05/Diabetes-Clinical-Strategy-2018-2023-
11.05.18.pdf
NICE 2017. Type 2 diabetes in adults: management. Retrieved from:
https://www.nice.org.uk/guidance/ng28
NICE Guideline 2015. Diabetes in pregnancy: management from preconception to the postnatal
period. Retrieved from: https://www.nice.org.uk/guidance/ng3/resources/diabetes-in-pregnancy-
management-from-preconception-to-the-postnatal-period-51038446021
Pons, R.S., Rockett, F.C., de Almeida Rubin, B., Oppermann, M.L.R. and Bosa, V.L., 2015. Risk
factors for gestational diabetes mellitus in a sample of pregnant women diagnosed with the
disease. Diabetology & metabolic syndrome, 7(91).
Reece, S.W. and Williams, C.L.H., 2014. Insulin Pump Class: Back to the Basics of Pump
Therapy. Diabetes Spectrum, 27(2), pp.135-140.
REPOSE Study Group, 2017. Relative effectiveness of insulin pump treatment over multiple
daily injections and structured education during flexible intensive insulin treatment for type 1
diabetes: cluster randomised trial (REPOSE). bmj, 356, p.j1285.
Röder, P.V., Wu, B., Liu, Y. and Han, W., 2016. Pancreatic regulation of glucose
homeostasis. Experimental & molecular medicine, 48(3), p.e219.

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Ross, P., Gray, A.R., Milburn, J., Kumarasamy, I.M., Wu, F., Farrand, S., Armishaw, J.,
Wiltshire, E., Rayns, J., Tomlinson, P. and Wheeler, B.J., 2016. Insulin pump-associated adverse
events are common, but not associated with glycemic control, socio-economic status, or
pump/infusion set type. Acta diabetologica, 53(6), pp.991-998.
Ross, P.L., Milburn, J., Reith, D.M., Wiltshire, E. and Wheeler, B.J., 2015. Clinical review:
insulin pump-associated adverse events in adults and children. Acta diabetologica, 52(6),
pp.1017-1024.
Shulman, R., Miller, F.A., Daneman, D. and Guttmann, A., 2016. Valuing technology: a
qualitative interview study with physicians about insulin pump therapy for children with type 1
diabetes. Health Policy, 120(1), pp.64-71.
Straus, S.E., Glasziou, P., Richardson, W.S. and Haynes, R.B., 2018. Evidence-based medicine:
how to practice and teach EBM. Elsevier Health Sciences.
Streisand, R. and Monaghan, M., 2014. Young children with type 1 diabetes: Challenges,
research, and future directions. Current diabetes reports, 14(9), p.520.
Tanenbaum, M.L., Hanes, S.J., Miller, K.M., Naranjo, D., Bensen, R. and Hood, K.K., 2017.
Diabetes device use in adults with type 1 diabetes: barriers to uptake and potential intervention
targets. Diabetes Care, 40(2), pp.181-187.
World Health Organization (WHO) 2018. Diabetes. Retrieved from:
https://www.who.int/about/role/en/

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Yorke, E. and Atiase, Y., 2018. Impact of structured education on glucose control and
hypoglycaemia in Type-2 diabetes: a systematic review of randomized controlled trials. Ghana
medical journal, 52(1), pp.41-60.
Zaccardi, F., Webb, D.R., Yates, T. and Davies, M.J., 2016. Pathophysiology of type 1 and type
2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084), pp.63-69.

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Appendix:
CW1- Case study:
The case study is related to a situation where a patient with T1D is experiencing stress
and physical health issues because of experiencing perceived burden due to the use of multiple
insulin injection throughout the day. The carer of the patient has been informed by a health care
staff that insulin pump is an effective technology that can reduce burden and provide lifestyle
flexibility to patient. However, the carer is confused whether the suggestion is appropriate or not.