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Re: [IP] I beg to differ....

Various IP members wrote:

>This article I came across really yanked my chain!

The full article is available here:


An Adobe PDF-format file is available for download here:


>At the present, I don't think you can find MORE THAN 3,526 members that 
>AGREE with you.

Yes, but IP members are not a representative, much less random, sample of 
diabetics. I suspect we're susceptible to more than a little bias with 
respect to treatment strategy.

>I doubt there's enough statistical power to detect anything but the most 
>obvious differences between MDI and CSII.

I'm not a statistician and the statistics are explained in the study 
report, but as sample size decreases, the size of the measured effect 
necessary to detect a statistically significant difference must increase. 
If one believes that the two treatment methods are *very* different, one 
might expect to see such a difference even in a sample of this study's size.

>It makes me wonder how they assessed the quality of life?

"At the final visit, patients were asked to complete the Diabetes Quality 
of Life (DQOL) questionnaire" ... also used by the DCCT.

>...this was not a simple experiment where an experimental group (CSII) was 
>being compared to a control group (MDI).

Yes, it was. Both groups were measured at the start of the test to develop 
a baseline. Then both groups were monitored for 9 months. Finally, most of 
the MDI group was switched to CSII for an additional 6 months.

>It could be that those on MDI were having those infamous highs and severe 
>lows that AVERAGED out to the above A1c, whereas perhaps those on H or the 
>pump were at a constant level and thus the above A1c.

Such differences would likely have been measured in the study either from 
tracking the number of severe hypoglycemic episodes or via the DQOL 

>I wouldn't give up pumping for anything because I found MY quality of life 
>very limited on MDI.

The study did _not_ attempt to measure the satisfaction of patients who had 
deliberately chosen to use the pump. Rather, it attempted to measure the 
clinical differences between Type 1 patients who had been randomly assigned 
CSII or MDI treatment regimens.

The study report included the following:

"Previous studies comparing CSII and MDI using human regular insulin have 
demonstrated that control of diabetes is improved in patients using CSII 
compared with those using MDI (4,5,21). Two of these studies were limited 
by not being randomized, with either physicians or patients choosing to use 
CSII (4,21). Therefore, the improvement noted in the CSII groups in these 
studies may be influenced by patient and physician bias. The [third] study, 
a randomized trial comparing outcome using CSII, MDI, or conventional 
twice-daily insulin injections, found that CSII was slightly superior to MDI."

>the 'control' group was only 27 people. This is NOT a legitimate study 
>with that few number of peole in their control group.

It's a legitimate study if the conclusions account for the uncertainty 
introduced by the sample size. Again, I'm not a statistician, but the study 
report certainly describes the statistics used and the conclusions pass the 
"sniff test."

>was this a study of people switching from 1 or 2 daily injections to MDI 
>vs. CSII?


>...the results don't seem in line with the experiences of the members of 
>this list.

Here's the study's final paragraph:

"Although clinical outcomes [between CSII and MDI] were similar in this 
controlled trial, individual patients may benefit significantly from CSII 
because of the increased flexibility in timing of meals and the increased 
options for basal insulin replacement. This may also apply to patients who 
have high rates of severe hypoglycemia. It is important for all patients 
with type 1 diabetes to have the option to select the therapy that is most 
suitable for them."

IMHO, that's a conclusion IP members can support.

regards, Andy
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