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[IP] Pump therapy and Medicare

This article I came across really yanked my chain! The statements made below
may be true for some individuals, but are not representative of the members
of this list. What do you think?

Linda V

Route of Insulin Administration Does Not Affect Outcome in Diabetics

My first reaction to the article was, "You've got to be kidding me!!"  Then,
reread it, and thought about it.  Had Hubby not been told of, encouraged to,
and had good support (here she is) to try pumping, he'd never had known the
advantages (got an hour or two to hear 'em all?).  He then probably would
remained "satisfied" with MDI.
I do have several comments about the article:
1) Anyone else notice that the CSII group started out with a 0.43 better A1C
baseline average?  Also, MDI for this study = 4, more, or fewer injections a
day (NB. Have ready articles where MDI is considered 3 or more injections a
day, and Medicare so defines)?
2)"Both groups of patients had significant decreases in HbA1c levels at all
time points, the team explains."  So, what were the numbers???  I tend to
think that MDI numbers weren't as good as the CSII group since no numbers
given.  Also, what were the blood sugar ranges for both groups, and how were
treatment changes decided?
3) "Hypo events"-again "numbers" in terms of how low, and treatment since we
know you can't "stop" intermediate or long acting insulins once they're in
system.  Hubby's found on those few (like 99% fewer) occasions when he's gone
low, the lows are easier to treat, don't sneak up the way they did on
injections so that he can usually catch them at say 60, not like before when
he'd be 200 and then 40 or lower, sometimes only 1/2-1 hr later.
4) Were all the persons in this study treated by Mount Sinai Hospital in
Toronto?  If so, then how do they do pump training and follow-up since I
for most pumpers, the number and severity of lows decreases markedly after
getting some semblance of control (eg. good basals and good insulin to carb
ratios)vs. MDI.
5)"Overall, the investigators found no differences in outcome between the two
[treatment] groups in terms of HbA1c levels, hypoglycemic events, or quality
of life measured using the Diabetes Quality of Life questionnaire."   Duh!  I
don't think so.  I can set up a questionnaire that would result in all
negatives about pumping by the choice of questions given (nope, ain't gonna)
so I'd like to read the whole questionnaire they presented.  If they did
general type of questions without differentiating for different treatments or
allow comments then the whole picture would not be seen.
6)  Yes: "The findings of our study indicate that the choice of the method of
intensive insulin therapy should be a matter of personal preference," Dr.
Zinman and colleagues conclude."  "It is important for all patients with type
1 diabetes to have the option to select the therapy that is most suitable for
them."  Finally, something with which to agree.

Marj, with Mike and "Ace the PP" right here rooting me on
Medicare has an interest in people dying off and getting off the SS Rolls, not
getting better care, that is window dressing on a dirty window.
MDI can give you better A1c numbers because of all of the lows. you could get
down to 5.8 if you keep shocking yourself. Medicare does not Advocate good
control for diabetes, they are interested only in reducing costs. PFuey!
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