Are Insulin Pumps Better Than Shots? (Continued)


What The Studies Say

So we must turn to science to see what works and what doesn't work. I did a mini-review of the scientific literature out there that looks at pumps vs. shots, and here's what I found: Looking at more than a dozen studies and two meta analyses that investigated the pump vs. shots issue (in science speak CSII—Continuous Subcutaneous Insulin Infusion—vs. MDI) I found that beyond scientifically confirming that pumps make people happy, all the studies disagreed about the medical benefit of pumps.


Yep. While a slew of studies supported pumps in improving blood sugar control in some fashion or another, oddly, there didn't seem to be any universal truths. Which explains why everyone is still arguing about the whole pump vs. shot thing. Some studies showed that pumps lowered A1C levels. Some showed no help with A1C, but that pumps improved glycemic variation. Some studies showed pumps helped adults, but not kids. Others showed they helped kids, but not adults. Some studies showed impressive slam-dunk improvements, others good improvements, while still others only marginal gains. My favorite, a British study, summarized its findings with the very British statement of "a modest but worthwhile improvement" was seen with pumps over shots. Some studies showed that only really out-of-control patients improved with pumps, suggesting that the bad boys and girls would be good pump candidates; while other studies showed that well-controlled people are the ones who get the most benefit from pumps.

And at least two studies showed that pumps aren't worth the cost, one study showing no health benefit of pumps over shots at all; and the other showing that people on shots actually did better than people on pumps.  

What the hell?

Well, the problem with science is that science can prove anything. No, that's a lie, but people with an agenda can pick and choose what science they want to look at or how they want to present the "facts" of the study. And, of course, not all science is equal. Add to that, science is surprisingly messy because it's run by human beings with all our faults. The design of most studies is supposed to correct for warped motivations, individual biases, big egos, and personal kingdoms. But the fact is, most of our medical science transpires in academic centers, where warped motivations, individual biases, big egos, and personal kingdoms are a fact of life and the notion of publish-or-perish is anything but abstract. I've actually seen smart, savvy, qualified academicians have panic attacks because they are behind on their expected number of publications. In academia, if you don't publish enough, you can literally lose your job. This leads to some rushed, sloppy work.

To make the picture even grimmer, much of the data collection and computer entry in academic medicine is done by students. Students who are wired on caffeine. Or bombed out of their gourds on alcohol or other fun recreational chemicals. Students, wired or bombed, who are simultaneously posting on Facebook and texting friends while they enter the study data into university computers. Late at night. On the Sunday before the study's final report is due. At 7:30 the next morning.

Oh, and remember I said that most clinical studies are done by academicians? The rest? By Pharma companies of course. Lucky we don't have to worry about any bias with those folks.

So this is the basis for Evidence Based Medicine. If you thought that medicine had come a long way since the shaman was throwing bones on the cave floor, you're dead wrong.

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Last Modified Date: June 17, 2013

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