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Re: [IP] Spreading the word about pumps
> I know that it is an on-going thing all over the world. But what
> I don't
> understand it WHY??? If pump therapy has been around since the 60's
> then why aren't the doctors getting training in this area in med
> schools? And if MDs are required CECs each year then why aren't
> endos being required to take a CEC course on the newest therapies?
Modern pump therapy has only really been around maybe 10 year. If you
want to stretch it you could say 15, but small compact reliable pumps
have only been with us about a decade or so, the first ones being
the Htron and the MM504 I believe. They have their predecessors, but
most had things like single basal rates, etc... Most of the docs in
practice now were trained BEFORE the newer pumps were in existence.
Until the DCCT, there was no data to suggest or prove that tight
control helped prevent complications and the DCCT did not address the
use of pumps although some later studies did some correlation of the
results and made some postive statements about pump use for tight
control. During the nineties, there were studies that supported
improved control and thus with the results from the DCCT demonstrated
that pumps will reduce complications, cost, etc.... associated with
diabetes. Recently (last 5 years or so) there have been a few studies
of adolescent and older kids. The first ones were inconclusive.
Recent ones have shown improvements with pump therapy (more modern
pumps) and unpublished work that I am aware of will reinforce this
for a large group as well as much younger kids.
Bear in mind that there are less than 500 pediatrice endo's in the
United States according to figures I looked at last year (but can't
Bottom line.... awareness of pumps is just starting to make it's way
into the mainstream. The first rule of medicine is to "do no harm".
Many ped endo's are reluctant to move forward because there have been
reports in the past of deaths on pumps, no improvement in control or
outcome, difficulty of use, etc.... Almost all of this is very old
news and related to pumps that pre date the kind of equipment we use
today. One thing that continues to hold back pumps for very young
kids is a lack of published data showing their efficacy and
improvement in outcomes due to their use. That information will be
forthcomming over the next few years and therefore I expect there
will be less resistance from the old guard docs. The unpublished data
I mentioned is due out in August as I recall and is from the endo
group at Yale which has a large pediatric pump population.
There are lots of things going on that will change the awareness of
pumps and make them more main stream. I think it will happen with a
much accelerated pace over the next few years as more studies are
published, more people become aware through groups like IP, and more
kids become pumpers.
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