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RE: [IP] Morbid morsel from BMJ article



Does anyone know when/if the DCCT will do another study? Another decade mark
would be next year. I hope they go and do some more research on the study :)

Connie Miller
Photography benefiting the Children With DIABETES Foundation.
If  9 out of 10 people that read this say NO, we still raise $300,000 this
year for CWDF.
If  9 out of 10 people that read this say YES, we raise 3 MILLION this year
to fund a porcine islet cell transplantation trial.
Are you with us? www.fundsfordiabetes.org

-----Original Message-----
From: email @ redacted
[mailto:email @ redacted]On Behalf Of Norbert
Mayer-Wittmann
Sent: Tuesday, March 26, 2002 1:46 AM
To: email @ redacted
Subject: [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.

MY PERSONAL VIEW

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.

Norbert
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for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
send a DONATION http://www.Insulin-Pumpers.org/donate.shtml