[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IP] FYI on # of Pumpers in the US

I get a newsletter from Medscape every now-and-then and this article was
included today.  Thought you would be interested in the very last paragraph
of it (I've added the italics and color (if the color comes through the

Roxanne Villanueva RD, LD
Cleveland, Ohio

Medical Journal</A>

Reemergence of Insulin Pump Therapy in the 1990s

L. Raymond Reynolds, MD, Department of Internal Medicine, Division of
Endocrinology and Molecular Medicine, University of Kentucky,

The publication of the landmark Diabetes Control and Complications Trial
results in 1993 provided a strong impetus to achieve near-normalization of
blood glucose levels in type I diabetic patients using intensive insulin
therapy programs. Recent studies show less hypoglycemia with this form of
intensive therapy and equivalent or improved glycemic control. Insulin pump
therapy is achieving wider acceptance and application in diabetes management.
This commentary reviews the current status of insulin pump therapy, including
indications and future directions. [<A
>South Med J</A> 93(12):1157-1161, 2000. )
2000 Southern Medical Association]


External insulin infusion pumps became generally available in the early
1980s, after initial studies suggested that normalization of blood glucose
levels was possible in difficult-to-manage cases of insulin deficiency.[1-4]
Pump therapy was widely applied to the most difficult cases, including the
most unstable from a metabolic standpoint. Frequently, psychosocial problems
emerged, precluding successful therapy.[5] The results were often
unsatisfactory and occasionally disastrous, usually the result of unrealistic
expectations or improper application of this technology.[6] Insulin pump
therapy became obscured by controversy and was used in only a small minority
of patients by the late 1980s.However, the multicenter Diabetes Control and
Complications Trial (DCCT) data showed that intensive insulin therapy
resulting in lower hemoglobin Alc (HbAlc) levels is associated with a
reduction in risk for microvascular complications.[7] The intensive therapy
group achieved an average reduction of 1.7% in HbAlc levels compared with the
conventional therapy group. Patients receiving intensive therapy were treated
either with insulin pump continuous subcutaneous insulin infusion (CSII) or
with multiple daily injections (MDI) of insulin, with nearly 50% receiving
CSII therapy during the study.[8] Adverse events associated with intensive
therapy included severe hypoglycemia, diabetic ketoacidosis (DKA), and weight
gain. Although there was a twofold to threefold greater risk for hypoglycemia
in the intensive treatment group, the absolute incidence declined in the
latter years of the study. Both conventional and intensive treatment groups
had weight gain, and the incidence of DKA was not increased with intensive
therapy. Importantly, intensive therapy was not associated with a decline in
quality of life.[9] Therefore, the DCCT results prompted the American
Diabetes Association to recommend that blood glucose control equivalent to
that achieved with intensive insulin therapy be the goal for most patients
with type 1 diabetes.[7] In the years before the release of DCCT data,
insulin pump therapy was reserved primarily for an elite group of motivated,
compulsive patients, free of complications, at specialized diabetes centers.
The risk of hypoglycemia was believed to be so great that patients with
hypoglycemic unawareness were generally excluded from this therapy.[10] Other
deterrents to insulin pump therapy included concerns about patient selection
criteria, pump reliability, and an increased risk of DKA and skin
infections.[11-14]Studies have shown a reduced risk of hypoglycemia with pump
therapy, with equivalent or lower HbAlc levels.[15-17]
Increasing numbers of patients are receiving this form of therapy. In 1997, a
reviewer estimated that 10,000 to 20,000 individuals received pump
therapy.[18] Current data* show a rapid growth in recent years, including
approximately 80,000 pump therapy patients in the United States.
> *Written communication, MiniMed Inc and Disetronic Inc, July 2000.
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml