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

I'm still digging the journal reference, my endo is one of the team who
developed/is developing the Edmonton protocol here in Edmonton.  There are
several variables in regards to these discussions that mant people seem to
be lumping together and/or disregarding.  These include everything from
blood pressude characteristics to variability of a persond schedule.  

A research study seeks to limit changes in many variables to focus on a
particular facet that has been deemed important. Some researcher choosing
different variables than another researcher can often be the source of
contradictions between studies that appear to be the same in their method.

	In regards to your son, it is highly likely that he has a rather
erratic schedule/eating habits.  HUGE assumption on my part not knowing his
age/lifestyle etc. but for my part THIS is the reason a pump is useful for
me.  But remember, one of the points made in the studies was that lifestyle
was deemed to be the major source of difference in effectiveness of pump
versus MDI therapies.  Am I saying "No matter what MDI is as good/better
than pumping."?  Heck no, read carefully.  "DEPENDING ON FACTORS INCLUDING
CERTAIN INDIVIDUALS".  Remember, individuals are not a statement of
generality for an entire population but rather an acknowledgement that
investigation and testing is required before arbitrarily making any
statement about which treatment is better. Without taking all the factors
into account (which is supposed to be the job of your endo/specialist) it is
anecdotal and irresponsible of us to try.

-----Original Message-----
From: Marisa Schmidt [mailto:email @ redacted] 
Sent: Friday, January 24, 2003 6:13 PM
To: email @ redacted
Subject: Re: [IP] A1c - 5.5 on MDI vs 5.5 on Pump

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Studies are only as good as the sources that did them.  So your memory of
unnamed sources is not a huge endorsement to me.  I can also say that I have
read studies and pulling from my memory, these studies show that pumps help
to maintain more normal blood glucose levels.  Also, I have done my own
personal study (sample of 1) and can assure you in my son's case the pump is
a vastly improved method of delivering insulin.  Just to see his basal
profile shows this.  His lowest basal is .15 and the largest is .6  It would
take a TREMENDOUS amount of testing and shots to provide for stable bgs for
him.  When I add sports into the picture, and the use of temporary basals,
the superiority of CSII is really evident.  I know that at in least some of
the islet transplant centers, it is a requirement that patients use pumps.

This thread seems to have changed from "are pumps a medical necessity" to
"MDI can be just as good as pumps."  It can't.

Not just my opinion.

----- Original Message -----
From: "Richmond, Raymond" <email @ redacted>
To: <email @ redacted>
Sent: Friday, January 24, 2003 5:27 PM
Subject: 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
> 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
> 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,
> 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.
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