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Re: [IP] Pumping and doctors


I think the reason doctors may be shying away from pumps (if indeed they
are; this factoid is news to me) is that there is no statistical evidence
in the medical literature that pumps are any better than multiple
injections at controlling diabetes. I'm sorry that's the case, but it's
true. I searched Medline from the mid-'70s to the present to try to find
some documented proof that pumps lower A1Cs or the incidence of
hypoglycemia and couldn't find a shred of evidence. It's upsetting to me,
because I *know* that in my case my hypo unawareness abated considerably
once I got a pump, but it hasn't been written down in a peer-reviewed
medical study that pumps are any better than multiple injections. That's
probably why quite a few HMOs simply won't approve them no matter what. 

Unfortunately, in the DCCT, no differentiation was made in their pub-
lished results between pumps and multiple injections. The patients in the
intensive therapy group were given a choice between multiple injections
and pumps, but the choice was theirs. About half chose pumps and the other
fifty percent multiple injections, and they could switch from one to the
other if they decided to. The statistics were overwhelming showing the
intensive therapy group had way fewer complications of all sorts over the
control group, but no statistics were kept to show that pumps were any
better than shots--unfortunately for the pump makers and for those of use
who like to think that pumps are clearly better than shots.

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