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Item
#5
Evidence
Base for the Expanding Use of Insulin Pump Therapy in Type 1
Diabetes
Continuous
Subcutaneous Insulin Infusion at 25 Years show that it works
A
quarter of a century after its introduction continuous
subcutaneous insulin infusion (CSII) is used in selected type
1 diabetic subjects to achieve strict blood glucose control.,
world-wide it is still increasing.
We
review the evidence base that justifies this increase,
including effectiveness compared with modern intensified
insulin injection regimens and concern about possible complications.
Review of controlled trials shows that, in most patients,
mean blood glucose concentrations and glycated hemoglobin percentages
are either slightly lower or similar on CSII versus multiple
insulin injections. However, hypoglycemia is markedly less
frequent than during intensive injection therapy. Ketoacidosis
occurs at the same rate. Nocturnal glycemic control is
improved with insulin pumps, and automatic basal rate
changes help to minimize a prebreakfast blood glucose
increase (the "dawn phenomenon") often seen
with injection therapy. Patients with "brittle" diabetes
characterized by recurrent ketoacidosis are often not
improved by CSII, although there may be exceptions.
We
argue that explicit clinical indications for CSII are
helpful; we suggest the principal indications for
health service or health insurance–funded CSII should
include frequent, unpredictable hypoglycemia or a
marked dawn phenomenon, which persist after attempts to improve
control with intensive insulin injection regimens. In any
circumstances, candidates for CSII must be motivated,
willing and able to undertake pump therapy, and
adequately psychologically stable. Some diabetic patients
with well-defined clinical problems are likely to benefit substantially
from CSII and should not be denied a trial of the
treatment. Their number is relatively small, as would therefore
be the demand on funds set aside for this purpose.
Diabetes Care 25:593-598, 2002
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DID YOU KNOW?
Prevalence
of diabetes increased inversely with income, especially among
women. Women who were single and 35 to 64 years old had a higher
prevalence of diabetes than women of the same age who were
married.
Department of Epidemiology and Community Medicine, Faculty
of Medicine, University of Ottawa, Ontario, Canada
By
referring your friends and colleagues to Diabetes in Control you
can win a free scholarship or expense check for the 2002 AADE
conference in Philadelphia.
http://www.diabetesincontrol.com/scholarship.shtml
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