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document
A cost-benefit comparison of intensive diabetes management with implantable pumps versus multiple subcutaneous injections in patients with type I diabetes . OBJECTIVE To investigate if intraperitoneal ( IP ) insulin infusion via programmable implantable pumps is a potential alternative to subcutaneous ( SC ) insulin via multiple injections . RESEARCH DESIGN AND METHODS We compared the cost-benefits of the two methods using a randomized , prospective , 6-month , crossover design in 10 adult type I diabetic patients . RESULTS When judged on the last month of IP versus SC periods in the nine patients who completed the study , metabolic data showed better glycemic control ( HbA1c : 7.2 +/- 0.2 IP vs. 8.5 +/- 0.7 % SC , mean +/- SE , P = 0.02 ) , reduced glycemic fluctuations ( SD of capillary glucose values : 3.4 +/- 0.2 IP vs. 4.6 +/- 0.2 mM SC , P < 0.01 ) , and fewer mild hypoglycemic events ( 5.7 +/- 2.0 IP vs. 10.0 +/- 3.1 events/month SC , P = 0.02 ) . Quality of life , judged by Diabetes Control and Complications Trial questionnaires , was unaffected by pump therapy . Direct costs , including pump acquisition , implantation , and follow-up , were 2.6-fold higher with IP than with SC delivery . CONCLUSIONS The implantable pump is more effective in the short term , equally accepted , but more costly than multiple injections and should be limited to patients with unsatisfactory glycemic control despite intensive diabetes management with SC insulin . In addition , longer-term , larger-scale , and comparative evaluation is required .
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Intervention_Physical
intensive diabetes management with implantable pumps
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Intervention_Pharmacological
multiple subcutaneous injections
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Intervention_Physical
intraperitoneal ( IP ) insulin infusion via programmable implantable pumps
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Intervention_Pharmacological
subcutaneous ( SC ) insulin via multiple injections
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Intervention_Physical
pump
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Intervention_Physical
implantable pump
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Intervention_Pharmacological
multiple injections
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Outcome_Other
cost-benefit
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Outcome_Other
cost-benefits
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Outcome_Physical
metabolic data
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Outcome_Physical
glycemic control
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Outcome_Physical
glycemic fluctuations
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Outcome_Physical
mild hypoglycemic events
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Outcome_Other
Quality of life
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Outcome_Other
Diabetes Control and Complications Trial questionnaires
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Outcome_Other
Direct costs , including pump acquisition , implantation , and follow-up
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Outcome_Other
effective
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Outcome_Other
accepted
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Outcome_Other
costly
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Outcome_Physical
glycemic control
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Participant_Condition
type I diabetes
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Participant_Sample-size
10
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Participant_Age
adult
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Participant_Condition
type I diabetic