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Re: [IPk] driving / DCCT results

> One of the problems with interpretation of the DCCT hypo results is that
> glycemic target for 3 am was too low . We would always be far more
> conservative than the DCCT in this inorder to avoid nocturnal and morning
> lows , or rebound hypers .
> All other pump studies show much lower hypo figures than the DCCT and show
> that insulin pump therapy can give better control measured by reduction in
> Hba1c and more importantly improved control WITH reduction of hypos and
> hypers  .
> Other US studies [ Bode ] and large european studies show the same
> beneficial results .
> John Davis at INPUT can provide you with a list of scientific references .
> Morag

Indeed, we've come a long way since 1993, and pumps have come further than
most in that time. There's no doubt either that the 'true basal' approach
(my term) of pumps is more physiological (like real life) than the approach
of MDI, and so results in less, and less serious, hypos.

Things are evidently better than they were, and will continue to improve,
for example as new very long acting insulins without a peak, such as insulin
glargine, come onto the market. In many ways these will act like a pump for
people on MDI, who will have steady basals provided by these insulins, and
boluses from a pen. They aren't quite as good as the pump though, as we all
know that some variation in basal rates is needed. No-one can control that
aspect of their insulin as fully as we can.

Tony O'Sullivan
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