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[IPu] Fw: [IP] AETMIS recommends targeted use of the insulin pump in the treatment of type 1 di

Hi All,
Canadian recommendations about Insulin Pump use in some T1's
----- Original Message ----- 
From: <email @ redacted>
To: <email @ redacted>
Sent: Tuesday, February 01, 2005 11:47 PM
Subject: [IP] AETMIS recommends targeted use of the insulin pump in the 
treatment of type 1 di

 MontrC)al, 2005-01-25 @ 14:07:57
Article in French:

AETMIS recommends targeted use of the insulin pump in the treatment of type 
diabetes MontrC)al, January 25, 2005 b The Agence dbC)valuation des 
technologies et
 des modes d'intervention en santC) (AETMIS) is today releasing a study on 
 insulin pump in intensive therapy for type 1 diabetes. This report, which 
 prepared in response to a request by the MinistC(re de la SantC) et des
 Services Sociaux, examines the safety and efficacy of the insulin pump and 
the economic
 aspects of introducing it into QuC)bec health-care system. The report also
 presents the patient and health professional perspectives in the QuC)bec
 context. The Aency concludes that the insulin pump offers advantages for a 
specific group
 of type 1 diabetics. It therefore recommends that the pump be recognized as 
 treatment modality that could be indicated for a limited, selected group of

 Diabetes: a disease on the rise

 Diabetes is a chronic, incurable disease, and its prevalence in the QuC)bec
 population is on the rise. Approximately 30,000 Quebecers have type 1
 diabetes, and the only treatment currently available is insulin therapy. 
Treatment with
 insulin injections can be conventional (two injections per day) or 
 (four to seven injections per day), but in both cases, the goal is to 
 normal blood glucose levels. Glycemic control is essential, both for
 preventing short-term problems, such as hypoglycemic episodes, and 
 complications, such as damage to the retina, kidneys and nervous system.

 The insulin pump Insulin therapy and its modalities have evolved over the 
past few years, and
 the intensive therapy recommended in practice guidelines can be 
 by multiple daily insulin injections or by continuous subcutaneous insulin
 infusion, also referred to as the insulin pump. It is a portable,
 battery-operated, programmable pump through which insulin is infused via a
 tube and a Teflon or metal cannula that is inserted under the skin.

 Targeted use for optimal outcomes

 An evaluation of the available evidence indicates that this technology is
 safe for motivated patients who are adequately trained and supported by a
 specialized team. Although the improvement in glycemic control offered by 
 pump is very modest for the general population of diabetic patients, it 
could be more
 significant for a specific subgroup of patients, in particular, certain
 patients who are unable to achieve adequate glycemic control with multiple
 injections. Although the cost-effectiveness data for the insulin pump are
 limited, they do seem to indicate that its use is cost-effective when it is 
 to selected patients.

 In light of this analysis, AETMIS recommends, among other things: 1) that, 
 set out in the Canadian practice guidelines, the preferred therapeutic
 approach to type 1 diabetes, in both adults and children, be based on
 intensive therapy with multiple daily insulin injections; 2) that a clear, 
 policy be developed for the use of the insulin pump as a treatment modality 
for a
 limited, selected group of patients with type 1 diabetes, with specific
 prescription and coverage modalities; and 3) that a multidisciplinary task
 force be charged with determining the parameters of an insulin pump access 
program in
 the QuC)bec context.


 Reporting to the Minister of Health and Social Services, the Agency has as
 its mission to advise and support, by means of assessments, policymakers in
 the health-care system with regard to the introduction, acquisition and
 utilization of health technologies and intervention modalities. Directed by 
 Board consisting of a maximum of 15 expert members, AETMIS employs about 30
 researchers and assessment specialists who examine the efficacy, safety and
 cost-effectiveness of health technologies, as well as the ethical, social,
 organizational and economic implications of adopting these technologies.

 b 30 b

 The report entitled Comparaison entre la pompe C  insuline et les
 multi-injections quotidiennes dbinsuline pour le traitement intensif du
 diabC(te de type 1, a summary of this report in French and an English 
translation of the summary
 are available on AETMISbs Web site at: www.aetmis.gouv.qc.ca. Copies can
 also be requested:

 By mail: email @ redacted
 By fax: (514) 873-1369
 By mail: Agence dbC)valuation des technologies et des modes 
 en santC) (AETMIS) 2021, avenue Union, bureau 1050 MontrC)al (QuC)bec) H3A 

Richard Lavoie
Tel.: (514) 873-9047

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