One Person's Critique if Pumps and CGM's

[Richard157]

A member on another site, from Copenhagen, Denmark made the following post. His/her statements may apply only to Denmark, I don't know. I would like to hear your comments. I do not agree with some of the statements made. He/she did not provide a link.

"A recent analysis of the records of CGMS and pump users showed that the average improvement in A1C was 0.5 . The average time spent by users to manage these devices was 50% more than with 5x MDI. There were notable increases in episodes of hypoglycemia and weight and no reductions in oter medical costs by by users.

The pump costs 3x vs syringes and CGMS 4x vs syringes and standard metering. When combined with the recalls and product defect reports on the pumps and CGMS systems available today in the US, there's no substantiation yet for the position that either is a significantly superior alternative to MDI by a well-educated person with diabetes.

When these devices are merged into a reliable moderate cost artificial pancreas that doesn't require user intervention they'll merit serious consideration, but until that time the users will be guinea pigs who will continue to drive up the cost of medical care with no improvements in outcome."
__________________
"Yesterday is history, tomorrow is a mystery and today is a gift."..........Eleanor Roosevelt

Diagnosed in 1945. Started pumping wit MM 522 in June, 2007.

[Lloyd]

My fasting glucose dropped from 200 -250 to 107 on the very first night of pumping.

I lost 35 pounds the first year of pumping.

The poster you speak of does not have a clue.

-Lloyd

[telizas]

Without any references to back this up, they may as well be saying that insulin pumps are alien devices that summon other-worldly beings to attack us in our sleep.

[Lloyd]

Oh, and my A1c went down 2 points after pumping.

When these devices are merged into a reliable moderate cost artificial pancreas that doesn't require user intervention they'll merit serious consideration, but until that time the users will be guinea pigs who will continue to drive up the cost of medical care with no improvements in outcome."

Makes a pump sound like a newfangled invention, huh?

A friend of mine has been pumping almost 30 years.

The above quote sounds like it came from someone who works for a government that would have to pay for a pump.

-Lloyd

[Richard157]

This is my reply to the person in Denmark:

My A1c had been below 6.0 for several years before I started pumping. It has not been significantly different since I began pumping in June, 2007. The reason I wanted to pump was to reduce the number of highs and lows I was having. It is a well kown fact that a roller coaster type of control can lead to diabetes complications even when the A1c's are consistently good. After adjusting to pumping my BG's are in the range 70-130 (3.9-7.2) about 90% of the time. Before pumping it was in that range about 70% of the time and I had rather frequent highs at 170 (9.4)or greater, and lows below 50 (2.8) that sometimes required my wife to feed me glucose. That has not happened for two years now. My roller coaster has leveled out considerably, it is no longer a bumpy ride. I was having mild retinopathy and some neuropathy before pumping. Those problems have vanished due to my more stable control, even though my A1c's have not improved. My pump has enabled me to be complication free. I know many Americans who are using much less insulin, are losing weight and have considerly lower A1c's than before pumping. I rather doubt that your statistics are valid for pumpers in the USA.
__________________
"Yesterday is hisory, tomorrow is a mystery and today is a gift."....Eleanor Roosevelt

Age 70. Type 1 for 64 years. Using a Minimed 522 pump. No complications. A1c = 5.8

[Richard157]

Apparently he is a US citizen, maybe working in Denmark? Here is his next post. He is now giving links.

"It gives me no pleasure as a US citizen that even though the US spends far more per capita, the US trails most EU countries in quality and access to education and access to medical care for diabetes. Unless you think that US citizens are better educated, better motivated or smarter than citizens of the EU, I don't see how you could conclude the statistics wouldn't apply, or that the US statistics might not be worse.

Being highly motivated, informed and educated is what enables you to apply technology successfully to your personal advantage. I wish that more persons with diabetes were equally competent and had equal access to the technology; but until cost-effective hands-off systems are introduced, (or Homo Sapiens Mark II) pump and CGMS technology has to be applied on a case-by-case basis.

The meta-study hasn't been released as it is undergoing review, but its findings aren't surprising; there are many individual studies that have results consistent with the metastudy going all the way back to the early 90's. Three things to consider when looking at an individual study is what was the study trying to prove, how did the control group differed from the intervention group, and who sponsored the study. The majority of studies with manufacturer sponsors have been primarily intended to prove that pumping and CGMS are safe and effective, not that they are more effective, and too often the control group receives no education. Newer studies are addressing these defects.

Here are some studies that are relevant:

Completed Trial
PUMP STUDY MDI Lantus/Lispro vs Continuous Insulin+Lispro
Comparison of a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) in type 1 diabetes: a randomized open parallel multicenter study.
http://www.ncbi.nlm.nih.gov/pubmed/19389820?dopt=Abstract

Comparison of Insulin Pump and Multiple Daily Injection Regimens in Type 1 Diabetic Patients (Children)
Author(s): Bassam S. Bin-Abbas, Abdullah Al-Fares, Nadia A. Sakati, Abdullah A. Al-Ashwal
Vol. 10, No. 1 (2006-10 - 2006-12)
http://www.indmedica.com/journals.php?journalid=13&issueid=107&articleid=1475&action=article

papers:
PubMed home (http://www.ncbi.nlm.nih.gov/sites/en...0&ordinalpos=1)
http://www.insulinpumptherapy.co.uk/...ers/index.html
JSMS | Insulin Pump Therapy: The Pros and Cons in Current Diabetes Management (http://thejsms.com/744/)

This publication from the Undersecretary for Health is interesting. It says flat out that efficacy of using pumps in an adult population was comparable to MDI. It raises the question of cost but it avoids answering it, http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2054

This site has data on the effective application of pumps to children, one of the best applications, since management of childhood diabetes has been very difficult to manage. Note though, that even with government subsidization and control of pharmaceutical industry profits, the cost is still more than double vs MDI.
http://www.insulinpumptherapy.co.uk/...ers/index.html

Ongoing Clinical Trials
"Study to Compare Efficacy of the MiniMed Paradigm REAL-Time System Vs. MDI in Subjects Naive to Insulin Pump Therapy"
Study Director: Scott W Lee, MD Medtronic MiniMed
Responsible Party: Medtronic Diabetes ( John Mastrototaro, VP, Global Clinical, Scientific and Health Affairs )
Study ID Numbers: CEP179/Z25
Study First Received: January 2, 2007
Last Updated: January 7, 2009
ClinicalTrials.gov Identifier: NCT00417989
Study to Compare Efficacy of the MiniMed Paradigm REAL-Time System Vs. MDI in Subjects Naive to Insulin Pump Therapy - Full Text View - ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00417989)

[SCC]

This makes me crazy. My A1C dropped 1.0 but my quality of life increased 5.0. I'm not sure cost is the entire equation here.

[Lloyd]

Insulin pumps are not for everyone, some people do not have the skills or desire to do what is necessary.

Note only one of the studies quoted is done in the US, where pumping is common, and medical professionals thus have the experience to weed out those who are not ready for a pump, or have little chance of success. That study is not yet complete.

In the UK, where the government has to pay for pumps, the government states that there is no evidence that a pump can help a Type 2.

This is both false and stupid. If you have dawn phenomenon, which is high fasting glucose due to a release of glucose by your liver while you are sleeping, a pump is by far the best method to treat this. It makes ABSOLUTELY NO DIFFERENCE if you are Type 1, or an insulin dependent Type 2.

On injections, I had an A1c of 6.9, but fasting readings of 200 to 250 every day.

My fasting readings are now 110 or less. My last 11 A1c's have been 5.5 or less.

I am an insulin dependent type 2.

But of course pumps don't help type 2's.

YEAH, RIGHT.

-Lloyd

[notme]

All I can say is for me, the difference was dramatic and did not follow the percentages posted. My A1c was not great on MDI. I worked very hard with Lantus, but it did not work for me. Lantus did not last 24 hours and splitting doses didn't help much. I did pretty poorly in comparison on MDI. When I started pumping my first A1c dropped from the mid 7 range into the mid to low 6 range.

I don't use CGMS because I really don't want to use possible pump sites for the CGMS patches. If I still have to test with a finger stick, I doubt I would want to mess with CGMS. Personal choice.

I totally disagree with the studies, in my case.

[Subby]

Richard, my thought is that pump efficacy should of course be studied and observed, but pulling a few cases out is hardly compelling to back up these assertions. The wheres, whos and hows of pumping as a preferable alternative are I think quite complex, (from such issues as the cost, availability, and commitment required) and the links are nothing like providing a homogenous or clear cut case as to justify such blatant antagonism to pumping as is clear from the "guinea pig" statement. This person just strikes me as being rather full of their own opinion and having made up their mind and with a bone to pick, from the start. Not helpful. I would suspect an agenda, whether it be professional or perhaps they emotionally don't want a pump themselves, or maybe they are just trying to be controversial and stir up trouble on your other forum. Don't know.