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Re: [IPk] NICE Guidelines



> I self fund. Would I have any hope of convincing my Consultant that he was
> wrong and that Glargine really didn't suit me?  I don't live in hope.
>
> Heather

You need to be under a pump centre or at least a consultant with good
understanding of the pump

>
>
>
>
>
>
> >From: Pat Reynolds <email @ redacted>
> >Reply-To: email @ redacted
> >To: email @ redacted
> >Subject: Re: [IPk] NICE Guidelines
> >Date: Mon, 27 Jan 2003 19:27:58 +0000
> >
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> >
> >In message <email @ redacted>,
> >Steven J Sexton <email @ redacted> writes
> > >Hi
> > >
> > >I am very wary of setting criteria to define when existing pump user
> >should
> > >switch back to MDI for a trial period. How long should that trial
period
> >be
> > >for?
> >
> >But criteria are needed, or people will be switched back in
> >appropriately.
> >
> >Given the criteria we've come up with here, is there _anyone_ on this
> >group who would be switched to a glargine trial?
> >
> >Remember, that means someone who: has a near-flat basal rate, and only
> >very occasionally uses temp basal, suspend, profiles or basal rate %
> >variation, and never uses square or dual bolus.
> >
> > >
> > >I would argue very strongly that for existing pump users that previous
> > >HbA1c's and medical history should be used and that should include
> >quality
> > >of life issues.
> >
> >Er, that's a criteria based decision. Or was your point that 'previous
> >HbA1c's and medical history should be assessed against criteria', with
> >the stress on the past, rather than new evidence against the criteria?
> >As I read it, they expect consultants to do exactly as you say, use the
> >past to make a judgement as to whether a glargine trial is likely to
> >give a good hba1c, without 'disabling hypos'.
> > >
> > >Presumably for most pump users who are currently funded by their Trust
> > >there was a "clinical" case for the PCT/Trust to fund them. Hopefully
> >with
> > >the FAD in its current form they would continue to receive funding, as
> >the
> > >clinical case had previously been made.
> >
> >What NICE is getting at is that when many people were put on pumps,
> >while there was a clinical case then, glargine wasn't around then, and
> >so everyone should go and have a trial with glargine before being
> >allowed back on a pump.
> >
> >The patent stupidity of that for anyone with varying basal rates (for
> >example) needs to be spelled out in the criteria.
> > >
> > >For those of use who are self funded, I would hope that our previous
> > >history would be sufficient to demonstrate that it would be extremely
> > >difficult to achieve an HBA1c of less than 7.5 on MDI without disabling
> > >hypos occurring.
> >
> >No, it won't be enough, unless you have tried glargine.
> > >
> > >The difficult area would be for those people who switched to a pump
> >through
> > >personal choice but previously had HBA1c's of less than 7.5 when they
> >were
> > >on MDI.
> > >
> >Again, if they got their under 7.5s with glargine, but had 'disabling
> >hypos', however that gets defined eventually, they are fine.  If this
> >was with another basal insulin, even if they had a string of ambulance
> >admitals, they could be forced to go and try glargine.
> >
> > >The way I am reading it at the moment is that people would be
recommended
> > >for CSII where MDI has failed ie people cannot maintain an HBA1c of
less
> > >than 7.5% without disabling hypos occurring. MDI would be any
combination
> > >of short/medium/long acting insulins.
> >
> >The way I read it, 'any 2 combinations, one of which must involve
> >glargine'.
> > >
> > >One query regarding the treatment of disabling hypos by third parties,
is
> > >does third parties include anybody capable of treating a person with a
> >hypo
> > >ie family, friends, work colleagues, passers by etc or would be
> >restricted
> > >to medically qualified people?
> >
> >I suggest we don't poke at this one for the moment - if we can get it
> >changed so that any significant hypo is a 'disabling hypo' - whether or
> >not it's self treated, unqualified treated, or medically qualified
> >treated, this won't be an issue.  If it goes through in the current
> >form, we need the vagueness, so that enlightened doctors can interpret
> >it as generously as possible (e.g. 'asked my husband to make me dinner
> >as I was feeling a bit shaky two hours later' could count as
> >'assistance'!).
> >
> >If we push against this now, NICE may come down with the tight decision
> >of 'treatment by the medically qualified'.
> >
> >Best wishes,
> >
> >Pat
> >--
> >Pat Reynolds
> >email @ redacted
> >    "It might look a bit messy now, but just you come back in 500 years
> >time"
> >    (T. Pratchett)
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>
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