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Re: [IP] Spreading the word about pumps

> Michael,
>   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? 

My theory....
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pumps) and unpublished work that I am aware of will reinforce this 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 
find now).

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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