title: [Cost benefits of intensive insulin therapy using injections, external pumps and implantable pumps].
abstract: Since feasibility is now proven, cost-efficacy of external sub-cutaneous (EXT) and implantable programmable (IMP) insulin pumps needs to be compared to those of intensified conventional insulin therapy (CONV). Only metabolic efficacy and short-term direct costs are easily evaluable. We (WHO-CSII Study) and others have shown that glycemic control and severe hypoglycemia risk are slightly improved, while ketoacidosis risk and costs are aggravated with EXT vs CONV. We (CEDIT Study) and others have shown that glycemic control, mild and severe hypoglycemic risks are improved, with no increase in ketoacidosis rates although a doubling in costs with IMP vs CONV. Rigid interpretation of the above data would limit indications of insulin pumps to patients experiencing frequent hypoglycemias while on intensified conventional insulin therapy.
authors.affiliation: Service de Diabétologie, Unité INSERM U.341, Hôtel-Dieu, Paris, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Selam
authors.forename: M J
authors.initials: MJ
authors.lastname: Haardt
authors.forename: C
authors.initials: C
authors.lastname: Berne
authors.forename: C
authors.initials: C
authors.lastname: Dorange
authors.forename: J L
authors.initials: JL
authors.lastname: Lanoe
authors.forename: J P
authors.initials: JP
authors.lastname: Bethoux
authors.forename: G
authors.initials: G
authors.lastname: Slama
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D005602:France; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007279:Injections, Subcutaneous / Q000191:economics; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000191:economics; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
vernacular_title: Coût-bénéfice de l'insulinothérapie intensive par injections, pompe externe et pompe implantable.