Article Text

Download PDFPDF

The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE): study protocol for a cluster randomised controlled trial
  1. David White1,
  2. Norman Waugh2,
  3. Jackie Elliott3,
  4. Julia Lawton4,
  5. Katharine Barnard5,
  6. Michael J Campbell6,
  7. Simon Dixon6,
  8. Simon Heller3
  9. on behalf of the REPOSE group
  1. 1Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
  2. 2Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK
  3. 3Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
  4. 4Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  5. 5Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
  6. 6School of Health and Related Research, University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Simon Heller; s.heller{at}


Introduction People with type 1 diabetes (T1DM) require insulin therapy to sustain life, and need optimal glycaemic control to prevent diabetic ketoacidosis and serious long-term complications. Insulin is generally administered using multiple daily injections but can also be delivered using an infusion pump (continuous subcutaneous insulin infusion), a more costly option with benefits for some patients. The UK National Institute for Health and Care Excellence (NICE) recommend the use of pumps for patients with the greatest need, citing insufficient evidence to approve extension to a wider population. Far fewer UK adults use pumps than in comparable countries. Previous trials of pump therapy have been small and of short duration and failed to control for training in insulin adjustment. This paper describes the protocol for a large randomised controlled trial comparing pump therapy with multiple daily injections, where both groups are provided with high-quality structured education.

Methods and analysis A multicentre, parallel group, cluster randomised controlled trial among 280 adults with T1DM. All participants attended the week-long dose adjustment for normal eating (DAFNE) structured education course, and receive either multiple daily injections or pump therapy for 2 years. The trial incorporates a detailed mixed-methods psychosocial evaluation and cost-effectiveness analysis. The primary outcome will be the change in glycosylated haemoglobin (HbA1c) at 24 months in those participants whose baseline HbA1c is at or above 7.5% (58 mmol/mol). The key secondary outcome will be the proportion of participants reaching the NICE target of an HbA1c of 7.5% (58 mmol/mol) or less at 24 months.

Ethics and dissemination The protocol was approved by the Research Ethics Committee North West, Liverpool East and received Medicines and Healthcare products Regulatory Agency (MHRA) clinical trials authorisation. Each participating centre gave National Health Service R&D approval. We shall disseminate study findings to study participants and through peer reviewed publications and conference presentations, including lay user groups.

Trial registration number ISRCTN 61215213.

  • Diabetes Mellitus
  • Type 1/therapy*
  • Insulin/administration & dosage*
  • Insulin Infusion Systems
  • Patient Education as Topic/methods*

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.