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Diabetes Care 28:763, 2005
© 2005 by the American Diabetes Association, Inc.

Letters: Comments and Responses

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections: The Impact of Baseline A1c

Response to Retnakaran et al.

Ian Blumer, MD, FRCP(C)

From the Charles H. Best Diabetes Centre for Children and Youth, Whitby, Ontario, Canada; and the Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada

Address correspondence to Ian Blumer, MD, 401-95 Bayly St. West, Ajax, ON L1S 7K8, Canada. E-mail: ian{at}ianblumer.com

Retnakaran et al.’s (1) recent pooled analysis showed improved glycemic control (when using rapid-acting insulin analogs) with continuous subcutaneous insulin infusion (CSII) therapy compared with multiple daily insulin injection (MDII). However, given that CSII users are known to be a well-motivated patient population with far greater adherence to particularly frequent glucose monitoring (often seven or more times per day) and also to have frequent contact with diabetes educators (specifically pump trainers), one wonders if similarly motivated, MDII-treated individuals might have had equivalent improvement in glycemic control. Do Retnakaran et al. have data reflecting objective determination of measures of motivation and adherence (such as frequency of blood-glucose monitoring, frequency of contact with diabetes educators, use or non-use of carbohydrate counting, etc.)? If so, could they comment as to whether this additional information would impact their analysis and conclusions?

References

  1. Retnakaran R, Hochman J, DeVries JH, Hanaire-Broutin H, Heine RJ, Melki V, Zinman B: Continuous subcutaneous insulin infusion versus multiple daily injections: the impact of baseline A1c. Diabetes Care 27:2590–2596, 2004[Abstract/Free Full Text]

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HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
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