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    Insulin Pump Better Than Multiple-Shot Regimen for Diabetics


    "This article confirms what others have confirmed: that with the pump, we can lower HbA1C, which means improving [blood sugar] control," says Bruce Bode, MD, who reviewed the study for WebMD. "That translates into a reduction in complications." Bode is an endocrinologist at Atlanta Diabetes Associates and medical director of the Diabetes Resource Center at Piedmont Hospital, also in Atlanta. He is also a consultant for Mini-Med, an insulin pump manufacturer, and for insulin makers Novo and Eli Lilly.

    While Paul Jellinger, MD, FACE, president of the American Academy of Clinical Endocrinologists, says experts have known for a while that patients on pumps require less insulin, study co-author Rita Odell, MEd, says "the reduction of insulin overall and the matching of insulin to food was a very positive outcome."

    Patients who are deciding whether to switch to a pump should think about why they want one, Bode says. "The main reason to use a pump is that you want to improve your blood sugar control and have more flexibility in your lifestyle -- to be able to eat, sleep, and work when you want. But someone who's not going to check their glucose shouldn't go on it."

    The pump is not for everyone, Jellinger says. "Many patients prefer not to be attached to things. There's no mandate to put a patient on the pump if they're doing well on [shots]. The best candidates are patients that ask to go on a pump."

    A big advantage of the pump is that it uses only the shorter-acting insulin, which gives a more predictable result than the longer-acting kind used by patients on injections, says Bode. Using short-acting insulin lessens the chance of making your blood sugar too low.

    Irl Hirsch, MD, of the Diabetes Care Center at the University of Washington, in Seattle, notes in an editorial accompanying the study that many physicians still struggle to get reimbursed for services related to switching patients to pumps, such as counseling by nutritionists and nurse-educators. "These important and talented personnel are required for all patients with diabetes, regardless of the type of diabetes and the type of medications used," he writes.

    He also questions the authors' assertion that all the study patients were measuring their blood sugar six to seven times daily, and wonders whether the frequency of home testing increased when the patients were using pumps. "Obviously, an increase in self-monitoring of [blood sugar] could account for some of the improved results," Hirsch writes.

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