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Mortality among Diabetic Patients Using Continuous Subcutaneous Insulin-Infusion Pumps

The New England journal of medicine, 1984-02, Vol.310 (6), p.361-368 [Peer Reviewed Journal]

1984 INIST-CNRS ;Copyright Massachusetts Medical Society Feb 9, 1984 ;ISSN: 0028-4793 ;EISSN: 1533-4406 ;DOI: 10.1056/NEJM198402093100606 ;PMID: 6419110 ;CODEN: NEJMAG

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Title:
Mortality among Diabetic Patients Using Continuous Subcutaneous Insulin-Infusion Pumps
Author: Teutsch, Steven M ; Herman, William H ; Dwyer, Diane M ; Lane, J. Michael
Subjects: Abscesses ; Adolescent ; Adult ; Age ; Aged ; Autonomic nervous system ; Biological and medical sciences ; Cardiovascular Diseases - mortality ; Creatinine ; Death ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 1 - drug therapy ; Diabetes Mellitus, Type 1 - mortality ; Diabetes. Impaired glucose tolerance ; Diabetic Ketoacidosis - mortality ; Diabetic Nephropathies - mortality ; Diabetic Neuropathies - mortality ; Disease control ; Endocarditis ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Equipment Failure ; Female ; Humans ; Insulin ; Insulin Infusion Systems - adverse effects ; Insulin Infusion Systems - mortality ; Insulin Infusion Systems - utilization ; Kidney transplantation ; Male ; Management. Various non-drug treatments. Langerhans islet grafts ; Medical sciences ; Metabolism ; Middle Aged ; Mortality ; Neuropathy ; Patients ; Risk ; Risk factors ; United States
Is Part Of: The New England journal of medicine, 1984-02, Vol.310 (6), p.361-368
Description: Because of concern about deaths among diabetic patients using continuous subcutaneous insulin-infusion pumps, we conducted an investigation to determine whether the number of such deaths was excessive. By October 1982 we had identified 35 deaths among the estimated 3500 diabetic patients using pumps in the United States. The observed number of deaths was not greater than the expected number calculated from age-specific death rates for conventionally treated patients with Type I diabetes. The causes of death were not unusual, with two exceptions. One death was associated with malfunction of the device, and the other was attributed to acute bacterial endocarditis that arose from an abscess at the catheterinsertion site. Patients who died had high rates of autonomic neuropathy (66 per cent) and renal disease (39 per cent with serum creatinine levels above 5 mg per deciliter). We conclude that the use of continuous subcutaneous insulin-infusion pumps is not associated with excess mortality. However, certain types of patients may be at greater risk for death, and physicians should take great care in selecting patients for pump therapy. (N Engl J Med 1984; 310:361–8.) CONTINUOUS subcutaneous insulin-infusion pumps are now widely available for achieving intensive glycemic control of diabetes. 1 2 3 These devices represent a series of technologic innovations in the treatment of diabetes. Because they have been introduced recently, little long-term experience is available, and small, short-term, clinical studies may be insufficient to detect rare but serious complications of their use. 4 , 5 Three unexpected deaths among patients using these pumps were reported at the National Diabetes Research Interchange Workshop in January 1982 (San Antonio, Tex.). 6 The importance of these deaths was uncertain since both the total number of deaths among pump users and the total number . . .
Publisher: Boston, MA: Massachusetts Medical Society
Language: English
Identifier: ISSN: 0028-4793
EISSN: 1533-4406
DOI: 10.1056/NEJM198402093100606
PMID: 6419110
CODEN: NEJMAG
Source: ProQuest One Psychology
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Mortality among Diabetic Patients Using Continuous Subcutaneous Insulin-Infusion Pumps

1984 INIST-CNRS ;Copyright Massachusetts Medical Society Feb 9, 1984 ;ISSN: 0028-4793 ;EISSN: 1533-4406 ;DOI: 10.1056/NEJM198402093100606 ;PMID: 6419110 ;CODEN: NEJMAG

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