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RE: [IP] A1c - 5.5 on MDI vs 5.5 on Pump

There were in fact at least a couple studies done comparing MDI to pumps in
this way. I will try to look them up the the journals for a reference but
I'm pulling this from memory.  

	The findings showed that on a fairly intensive MDI program compared
to pump with carb counting in both cases that there was a negligible
difference, almost zero really difference between the 2 methods.  This
specifically looked at blood glucose values and the ranges that they would
hit as well as the A1c values. On average (excluding exceptionally good and
bad pumpers as well as MDI patients) the majority exhibited highly
comparable numbers in both sampled BG values as well as A1c.  

	If I recall correctly one of the studies ran for ~5 months and had
the participants wearing the minimed cgms system to perform the logging.
The major differences noted related to lifestyle more than anything, people
with erratic schedules tended to do better on the pump than on MDI while
lifestyle regulated patients did about equally as well pump or MDI.

-----Original Message-----
From: Contreras, Eloisa (Eloisa) [mailto:email @ redacted] 
Sent: January 24, 2003 12:12 PM
To: 'email @ redacted'
Subject: [IP] A1c - 5.5 on MDI vs 5.5 on Pump

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After reading all the postings regarding medical necessity and Ryan
saying/writing if you can reach 6s with shots and no lows then there is no
medical necessity since the reduction in complications between a 6.5 and a
5.5 are negligible.  

I know that most of us are tired of reading about the subject but it got me

The number/severity of complications between 5.5 and 6.5 were measured using
MDI not using a pump (or at least the majority of the people in the study
were on injections and not pumps.)  Meaning, although you had a 5.5 more
than likely you were seeing  lots of highs and lows that average to a 5.5.
I know there might have been the few blessed with 95% of reading within the
5.5 range (what ever it is since we do not seem to agree what the A1c really
mean in BGR) but it must have been rare.  

If that was the case, then you cannot compare an A1c from MDI to one of
pumping.   Meaning *in general* the A1c from a well controlled pumper are
not equal to those of a well controlled MDI patient.  I would expect the
level of complications of a 5.5 (from a leveled average of readings) pumper
better than a 5.5 of a average/cancellation of many highs and many lows.

I wonder, if they were to do such study today, with the use of pumps vs. the
use of MDI if there would be a bigger difference in the number/severity of
the complication between 5.5 and 6.5, hence helping out the whole medical
necessity issue.

I am still very upset, that someone can see medical necessity for oneself
but questions that of others.  I am cautious of what I ask from my Dr, since
I do not want my premiums or my coverage to worsen, but I would have never
question my or anyone's (willing to the work) need for a pump.  

Eloisa and Bombita (MM's Paradigm)
I think this week was said to be the coldest week in 13 years in our area.
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