DESCRIPTION
Chronic intermittent intravenous insulin therapy (CIIIT) is a technique for delivering outpatient variable-dose insulin to diabetic individuals with the goal of improved long-term glycemic control. Through an unknown mechanism, CIIIT is postulated to induce insulin-dependent hepatic enzymes to suppress glucose production. The insulin administration is typically offered in specialized clinics. CIIIT may be delivered in pulses or as a drip solution and is adjunctive to the individual’s routine diabetic management regimen (oral agent or insulin-based) or other disease management regimen. Additionally, CIIIT may be performed on an intermittent basis (often weekly) and chronically without duration limits.
This therapy is also sometimes referred to as outpatient intravenous (IV) insulin therapy (OIVIT), Hepatic Activation Therapy (HAT), Intercellular Activation Therapy (iCAT), Metabolic Activation Therapy (MAT), Physiologic Insulin Resensitization Therapy (PIR), Pulsatile Intravenous Insulin Treatment (PIVIT), Pulse Insulin Therapy (PIT), and Pulsatile Therapy (PT).
Note: This policy does not apply to the use of intravenous insulin infusions in the inpatient setting.
POLICY
Chronic intermittent intravenous insulin therapy is considered investigational.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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SOURCES
American Association of Clinical Endocrinology. (2022). Clinical practice guideline: developing a diabetes mellitus comprehensive care plan – 2022 update. Retrieved October 20, 2023 from www.aace.com.
American Association of Clinical Endocrinology. (2023). Consensus statement: comprehensive type 2 diabetes management algorithm – 2023 update. Retrieved October 20, 2023 from www.aace.com.
American Diabetes Association. (2023, January). Standards of care in diabetes – 2023. Retrieved October 20, 2023 from www.diabetes.org.
Aoki, T. T., Benbarka, M. M., Okimura, M. C., Arcangeli, M. A., Walter, R. M., Jr, Wilson, L. D., et al. (1993). Long-term intermittent intravenous insulin therapy and type 1 diabetes mellitus. Lancet, 342 (8870), 515–518. Abstract retrieved October 23, 2023 from PubMed database.
Aoki, T. T., Grecu, E. O., Prendergast, J. J., Arcangeli, M. A., & Meisenheimer, R. (1995). Effect of chronic intermittent intravenous insulin therapy on antihypertensive medication requirements in IDDM subjects with hypertension and nephropathy. Diabetes Care, 18 (9), 1260–1265. (Level 2 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (3:2023). Chronic intermittent intravenous insulin therapy (2.01.43). Retrieved October 18, 2023 from https://www.bcbsaoca.com/eps/. (10 articles and/or guidelines reviewed)
Centers for Medicare & Medicaid Services. CMS.gov. (2009). NCD for outpatient intravenous insulin treatment (40.7). Retrieved October 10, 2023 from https://www.cms.gov.
Dailey, G. E., Boden, G. H., Creech, R. H., Johnson, D. G., Gleason, R. E., Kennedy, F. P., et al. (2000). Effects of pulsatile intravenous insulin therapy on the progression of diabetic nephropathy. Metabolism: Clinical and Experimental, 49 (11), 1491–1495. Abstract retrieved October 23, 2023 from PubMed database.
Weinrauch, L. A., Sun, J., Gleason, R. E., Boden, G. H., Creech, R. H., Dailey, G., et al (2010). Pulsatile intermittent intravenous insulin therapy for attenuation of retinopathy and nephropathy in type 1 diabetes mellitus. Metabolism: Clinical and Experimental, 59 (10), 1429–1434. Abstract retrieved October 23, 2023 from PubMed database.ORIGINAL EFFECTIVE DATE: 3/1/2024
MOST RECENT REVIEW DATE: 3/1/2024
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