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<blockquote data-quote="tim2000s" data-source="post: 904713" data-attributes="member: 30007"><p>Actually, the NICE evidence for pumps (CSII) isn't as bad as you make out [USER=102150]@Spiker[/USER]. </p><p></p><p>A total of 46 studies reported HbA1c levels before and after CSII therapy. Of these, all 18 studies in the adult/mixed age group showed a statistically significant decrease in HbA1c levels (in the range 0.2–1.4%) after initiation of CSII therapy.</p><p></p><p>Of the 23 studies in the children/adolescent age group, 20 studies showed a decrease in HbA1c levels after starting CSII therapy (in the range 0.2–1.2%) with the difference reaching statistical significance in 13 studies.</p><p></p><p>The other aspect of this which is important from a NICE point of view is the reduction in Hypos, and this was also statistically significant.</p><p></p><p>Twenty-six observational studies compared the rate of severe hypoglycaemic episodes in people receiving CSII and MDI therapy. Of the 10 studies in the adult/mixed age groups, eight reported statistically significant decreases in the rate of severe hypoglycaemic episodes after starting CSII therapy.</p><p></p><p>Of the 11 studies in children and adolescents, one had no severe hypoglycaemic episodes and the other 10 reported decreases in their frequency following initiation of CSII therapy, with rate ratios in the range 0.12–0.80. In four of these studies, the reduction was statistically significant, three did not report significance, and three did not show a statistically significant decrease. </p><p></p><p>The clinical specialists emphasised the robustness of the evidence that allowed the decrease in HbA1c levels to be used as a reliable proxy for avoidance of the long‑term complications of diabetes mellitus. </p><p></p><p>As a result, the evidence gathered here was considered as a strong positive for pump therapy.</p></blockquote><p></p>
[QUOTE="tim2000s, post: 904713, member: 30007"] Actually, the NICE evidence for pumps (CSII) isn't as bad as you make out [USER=102150]@Spiker[/USER]. A total of 46 studies reported HbA1c levels before and after CSII therapy. Of these, all 18 studies in the adult/mixed age group showed a statistically significant decrease in HbA1c levels (in the range 0.2–1.4%) after initiation of CSII therapy. Of the 23 studies in the children/adolescent age group, 20 studies showed a decrease in HbA1c levels after starting CSII therapy (in the range 0.2–1.2%) with the difference reaching statistical significance in 13 studies. The other aspect of this which is important from a NICE point of view is the reduction in Hypos, and this was also statistically significant. Twenty-six observational studies compared the rate of severe hypoglycaemic episodes in people receiving CSII and MDI therapy. Of the 10 studies in the adult/mixed age groups, eight reported statistically significant decreases in the rate of severe hypoglycaemic episodes after starting CSII therapy. Of the 11 studies in children and adolescents, one had no severe hypoglycaemic episodes and the other 10 reported decreases in their frequency following initiation of CSII therapy, with rate ratios in the range 0.12–0.80. In four of these studies, the reduction was statistically significant, three did not report significance, and three did not show a statistically significant decrease. The clinical specialists emphasised the robustness of the evidence that allowed the decrease in HbA1c levels to be used as a reliable proxy for avoidance of the long‑term complications of diabetes mellitus. As a result, the evidence gathered here was considered as a strong positive for pump therapy. [/QUOTE]
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