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[IPk] editorial in the British Medical Journal

HI there -

The British Medical Journal has an editorial by John Pickup about insulin
pumps. In part, they say:

We suggest that a trial of continuous subcutaneous insulin infusion is
indicated in patients with type 1 diabetes with frequent, unpredictable
hypoglycaemia or a marked dawn blood glucose rise, whose poor control
persists in spite of optimised insulin injection therapy (including
educational support and attention to blood glucose self monitoring and
injection technique). Some patients who lead unpredictable lives with
delayed meals experience wide swings in blood glucose concentration and are
particularly liable to hypoglycaemia when they try to tighten control with
injection therapy. The few pregnant patients with diabetes who fail to
achieve impeccable control with injections should also be considered. All
candidates should be willing to learn about and undertake pump therapy and
its associated procedures such as regular blood glucose monitoring; this
includes patients well controlled on insulin injections who simply prefer
pump therapy and are willing to pay for their pumps and supplies. People
with psychological problems and major psychiatric disorders tend not to do
well in meeting the demands of continuous insulin infusion. Proper
facilities for pump training and medical supervision must be in place. In
view of the limited numbers of patients and expertise needed, pump care
should normally be delivered at specialist centres.

If clinical guidelines on the use of continuous subcutaneous insulin
infusion can be agreed then NHS funding should also be committed for the
relatively few patients for whom it will make a difference. For them
continuous insulin infusion can substantially improve the quality of their
lives and the course and outcome of their diabetes.

It seems to me that they're setting too-strict guidelines for pumps. What do
other people think?

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