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[IP] Morbid morsel from BMJ article

Hi folks! This excerpt is not intended for people who are uneasy with the British view of health costs:

In people with intensively controlled glycaemia the absolute risk reduction for sustained progression in retinopathy (three steps on the early treatment of diabetic retinopathy scale) associated with a difference in HbA1c of 0.5% was about 0.5 cases per 100 patient years. Thus, maintaining this difference in control between insulin pump and injection therapy for 10 years would reduce the number of patients developing retinopathy of this degree by about 5%. The cost effectiveness of insulin pump versus insulin injections for this degree of benefit will need to be assessed.

What that means is: if you switch to a pump, that would (only?) prevent 5 cases of retinopathy per 100 cases (per decade). Note, however, that this conclusion is reached on the basis of including statistics from DCCT (don't know enough about statistical methods to be able to tell whether or how kosher that is). That this "needs to be assessed" means: it might not be worth it.

That these people seem to know very little about pump therapy shows from the fact that hyPERglycemia and ketoacidosis were not even mentioned. Also not covered: site problems.

On the conclusion:

However we consider that in general insulin pump should be reserved for those with special problems such as unpredictable hypoglycaemia or a marked increase in blood glucose concentration at dawn, despite best attempts to improve control with optimised injection regimens.

Anyone who wants/needs a pump should simply get up a couple times at night to measure BGs and thereby demonstrate the he/she has a "special problem" (most diabetics are "special", right?): dawn phenomenon.


It IS possible to get by without a pump. Every person should choose what fits best with that person. Health care professionals ("teams") should consider this, because a happy patient is more likely to stay healthy than an unhappy one.

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