The greatest deviation (pump −8.5%, MDI −10.5%) was observed for the smallest cohort with a strict definition of continuous treatment and no imputation (complete cases cohort D2) (Supplementary Table 3 and Supplementary Fig. and K.S.C. The risk also increased with age and disposable income, which may relate to sickness benefits being contingent on having a certain level of income. A Swedish health technology assessment review in 2013 did not find evidence for differences in severe hypoglycemia between pump therapy and MDI but identified indications of lower HbA1c (13). Insulin pumps are expensive and no matter the style or brand will cost at least several thousand dollars. 2. With the use of time-varying propensity scores, we allowed selected MDI control subjects to switch to pump therapy rather than to condition their eligibility or noneligibility on a future therapeutic change. Years for which individuals had no available data in population registers, for instance, because of migration, were excluded together with those of matched control subjects, unless the control subject had switched to pump therapy and thus had been censored as a control. The costs of production loss were somewhat underestimated. References. developed the study concept and design, interpreted data, and critically revised and completed the manuscript. The average cost difference between insulin therapies in this study and a 20-year time horizon roughly correspond to a discounted (3%) lifetime cost difference of $62,000. Therefore there should be no economical hindrance for the patient to be treated with insulin pump. Production loss was approximated as the sum of sickness benefit, early retirement benefits, and unemployment benefits. still is. The costs of insulin were calculated by two methods: insulin dispensed and insulin used. Available from, Swedish National Board of Health and Welfare (Ed.). E.T.G. The sensitivity analyses of cohort specifications and matching criteria indicated that average annual costs for individuals with type 1 diabetes were robust and similar to results from the main analysis (pump therapy range −0.6% to −8.5%, MDI range 0.5% to −10.5%) (full results in Supplementary Table 9). Gothenburg, Sweden, Centre of Registers Västra Götaland, 2016, Swedish National Board of Health and Welfare. Continuous subcutaneous insulin infusion, or insulin pump, therapy for individuals with type 1 diabetes has increased gradually since the 1980s. Social insurance payments underestimate the value of lost production because they are subject to floor and ceiling effects and are lower than wages. “Whether insulin pump therapy is cost-efficient, ultimately, depends on therapeutic effects beyond resource use and costs as well as on how much the payer is prepared to invest in additional quality-adjusted life-years,” the researchers wrote. In addition, higher HbA1c levels at enrollment in the Swedish National Diabetes Register were associated with increased costs (P <.001), as was starting therapy at age 18 years or older compared with younger (P < .001). Between 1,000 and 1,500 new individuals were entered yearly in the NDR in 2002–2012. In principle, optimal glycemic control may be achieved by either MDI or insulin pump therapy. © 2021 by the American Diabetes Association. Supplementary Table 7 shows results by three alternative model specifications. For moderate insulin users, the costs were about the same at $22,380 for injections and $23,002 for pump therapy. Make sure you speak to your diabetes specialist about if this is the best option for your child. In the UK you get injections on the NHS while you might have to pay for a pump. Insulin pump costs The cost of insulin pumps is often between £2000 and £3000. The strength of this observational study is the size and completeness of the study population, with virtually all adults with type 1 diabetes in Sweden included, longitudinal national register data, and a matching technique that accounts for time-variant variables, including diabetes duration, diabetes-related conditions and comorbidities, and demographic and socioeconomic factors. This observational study calculated costs of insulin pump therapy and MDI in individuals with type 1 diabetes using real-world data with 9 years of follow-up. The smaller difference was driven by lower health care costs and production loss in the pump group. Neither has received payment outside of normal salary related to the subject matter of this work. Cox proportional hazard functions were used to account for time-variant covariates in the matching equations and to model the time since last measurement for control subjects (7). Stockholm, Sweden, Socialstyrelsen, 2016 (publication no. Since an insulin pump is delivering rapid-acting insulin all the time, you most likely will have too much insulin in your system for any type of spontaneous movement the majority of the time. Data from the Swedish National Diabetes Register (NDR) have shown a lower incidence of some cardiovascular events and all-cause mortality for individuals with type 1 diabetes on insulin pump therapy in 2005–2012 (5). While there are many different insulin pumps available on the market, there are typically two kinds of pumps you can get. Semilogarithmic population-averaged panel data regression analysis was used to investigate the correlation between total costs and explanatory variables with and without a time trend. If that were the case, the incidence of diabetic complications would not differ between the two treatment alternatives, at least not those associated with maintaining adequate glycemic control. Visit www.pparx.org or call 1‑888-4PPA-NOW. Without insurance, a new insulin pump costs about $6,000 out of pocket, plus another $3,000 to $6,000 annually for ongoing supplies, like batteries and sensors. Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. The overall incidence rate of first events with cardiovascular disease for this study cohort was 9 per 1,000 person-years, whereas the corresponding figure for the previous study was 12.5 per 1,000 person-years. A total of 35,921 individuals with type 1 diabetes had at least one entry in 2002–2012 and were eligible for this study. Table 3 shows the adjusted results of the cost-regression analysis, controlling for time-varying demographic and socioeconomic factors. 2019;doi:10.2337/dc18-1850. Extended bolus. With tube insulin pumps cost around $4000-$5000 each, while tubeless pumps cost around $6000-$7000 each. Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). The pump acquisition cost was amortized over 5 years. This cohort contained the highest number of individuals. When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. We had 73,920 person-years of observation with a mean follow-up of 5 years per participant. Talk to your health care provider about your diabetes management plan, including diet and exercise. But if self funding, let's say 4 injections a day vs a pump. Our national real-world longitudinal data show additional costs for insulin pump therapy. Background Facts 2016: 1. Control subjects on MDI were matched 2:1 using time-varying propensity scores. Pump users had more outpatient appointments (3.8 vs. 3.5 per year; P < 0.001) and were less likely to have person-years without use of outpatient or inpatient care (9% vs. 12% of person-years). A small difference was found in mean sickness benefits between the treatment groups but no significant difference in early retirement benefits. Total costs were higher for women but decreased with years of education and disposable income. If you have an insulin pump on the NHS , you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. share joint last authorship. Subgroup analyses indicated an expected variation in level of annual costs by age and duration of diabetes. Toresson Grip E, et al. 2016:1) [in Swedish], Swedish Agency for Health Technology Assessment and Assessment of Social Services (Ed.). Now, with the pump, it’s one injection every 3 days. E.T.G., A.-M.S., M.M., B.E., S.F., S.G., and K.S.C. Health care costs are higher for Swedish adults with type 1 diabetes who use insulin pump therapy compared with those who use multiple daily injections, according to findings published in Diabetes Care. Objectives To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. AIMS: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. OBJECTIVE To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. We accounted for nonrandom selection into type of insulin treatment by propensity score matching conditioned on clinical, individual, and socioeconomic factors. This might be beneficial for some, but a psychological downer for others. Cost & Reputed Branded Insulin Pump. Most people in the UK who have a pump have it funded by the NHS. To estimate the incremental cost-effectiveness ratio (ICER) of the use of continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in adult patients with type 1 diabetes (T1D) at the Mexican Institute of Social Security (IMSS). Typical costs: According to the Academy of Managed Care Pharmacy [ 1 ] , insulin pumps cost between $4,500 and $6,500 for individuals without insurance. With an insulin pump, it’s harder to hide. DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. 4). Association Of Insulin Pump Therapy Vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, And Glycemic Control Among Children, Adolescents, And Young Adults With Type 1 Diabetes. Yet, a Cochrane review concluded in 2010 that although some evidence indicates that insulin pumps improve glycemic control compared with standard multiple daily injection (MDI) therapy, insufficient evidence exists regarding mortality, morbidity, and costs (1). When it comes to scientific studies, comparing various outcome parameters of insulin pump vs. multiple daily injection therapy have yielded mixed results. Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. Abstract Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. If you need assistance with prescription costs, help may be available. Also, being attached to the pump via tubing or pod is a 24/7 thing and for some this makes a pump a constant reminder of diabetes. 1 shows a flowchart of study inclusion and exclusion. The higher annual costs observed in the main analysis were driven by more health care resource use and loss of production in the broadest population, while cohort D2 included only very regular individuals with complete observations. Total daily insulin doses were also lower with an insulin pump therapy (0.84 U/kg) than with injections therapy (0.98 U/kg); (difference, −0.14 [−0.15 to −0.13], P < .001). Each method of administering insulin has advantages and disadvantages. Mean annual costs were higher for pump therapy than for MDI therapy ($12,928 vs. $9,005, respectively; P < 0.001; mean difference $3,923 [95% CI $3,703–$4,143]). Cost of medications and disposables by Swedish pharmacy official retail prices were taken from the Swedish Prescribed Drug Register. Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. Subgroup analyses by age indicated that the value of improved prevention may take time to manifest. The Swedish National Diabetes Register. Periods of sick leave <14 days are not included in national registers, and some of the workforce may not yet be eligible for unemployment benefits (e.g., young people with short contracts). Supplementary Figure 2A–C shows the distribution of age, diabetes duration, and HbA1c level at baseline (index date). We observed only a few deaths (n = 353 [2.5% main analysis sample], no difference pump vs. MDI [OR 0.98 (95% CI 0.79–1.23)]) and similar rates of cardiovascular disease for pump and MDI in this study, except for borderline significantly fewer events with angina in the pump group. Pump users were less likely to have a period of unemployment (unadjusted OR 0.803 [95% CI 0.721–0.894], adjusted OR 0.821 [0.736–0.915]). The authors thank the regional NDR coordinators and contributing nurses, physicians, and patients. No tedious technical management. share joint first authorship. designed and conducted the matching of study cohorts. It really depends where you live! In line with previous studies from the NDR, a cardiovascular event included any subsequent admissions or appointments within 28 days. Individuals were included in the analyses up to 31 December 2012, and each observation was followed until 31 December 2013 for all outcomes. The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? The difference in annual costs between the main analysis and the subgroup analyses was more pronounced for individuals with MDI versus pump therapy. For instance, 1.5% of person-years had a cardiovascular event, and 5% had at least one health care contact with a cardiovascular diagnosis. Observational studies provide a better indication of what is achieved in daily medical practice than randomized controlled studies (12). Funding. Health care costs, including medications and disposables, accounted for 73% of the costs for pump therapy and 63% of the costs for MDI therapy. The Supplementary Data further describes the costing strategy and variables (Supplementary Table 2). A study from the NDR investigated the association between insulin pump therapy and cardiovascular disease (5). This large nationwide study of 4,991 individuals with type 1 diabetes and insulin pump therapy and 9,247 propensity score–matched control subjects with MDI treatment showed higher annual total costs for pump therapy (∼$3,900). The main study variables were number of inpatient and outpatient events; costs of inpatient care, outpatient care, medication, and disposables; sickness benefit, early retirement benefits, and unemployment benefits; and all data summarized annually. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. No worrying. 4) Expense With pumps, cost is surely a consideration. Cost of a pump is prohibitive ... about a 300 mg/dL because the insulin isn’t getting through a new infusion site properly than simply taking 1 basal insulin injection and 4 to 6 rapid-acting bolus injections per day. However, real-world data on health care and societal costs of insulin pump therapy compared with MDI therapy are scarce. The account is genuine, typical and documented. The study cohort was young (mean baseline age 34 years) with relatively few diabetic complications in both study groups. The difference in research questions between this study and the NDR study required alternative estimation methods. No worrying. Here’s how it works. If you live in certain areas of the country, you may have to use specific pump suppliers for Medicare to pay for an insulin pump. © 2019 by the American Diabetes Association. and K.S.C. Of the total cohort, 4,991 used insulin pump therapy (mean age, 33.8 years; 51.1% women). Sensitivity analyses were used to explore two alternative definitions of continuous insulin pump therapy (liberal = 1, strict = 2) and four strategies (A–D) for imputing missing variable information (last value carried forward, first value carried backward, model-based single imputation, no imputation), which generated eight different and overlapping cohorts (A1–D2) (Supplementary Table 3). Use of real-world data implied imperfect entry over time for treatment and missing data among the clinical variables in the NDR. The study cohort was younger than the average individual with type 1 diabetes in the NDR (34 vs. 46 years), had a shorter duration of diabetes (21 vs. 24 years), and had a higher HbA1c (8.1 vs. 7.8% [65 vs. 62 mmol/mol]) at baseline. Insulin Pump Cost Comparison. Extended bolus. S.G. has received personal fees (lecture fees and research grants) from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk, and Sanofi outside the submitted work. Now, with the pump, it’s one injection every 3 days. The costs of insulin were calculated by two methods: insulin dispensed and insulin used. Pump users had higher average costs for outpatient treatment ($1,665; 95% CI, 1,615-1,714) compared with multiple daily injection users ($1,507; 95% CI, 1,473-1,542). A relevant research question from a health care planning perspective is whether real-world data match earlier model-based predictions for differences in resource use and costs. The second type of insulin pump is a patch pump. The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic? According to the same website, the average insulin pump price, is expensive and some patients cannot afford it, not without the help of their insurance coverage. Subgroup analyses revealed expected and substantial differences in average annual costs by diabetes duration and age (Fig. BMJ. Each individual provides informed consent. Registration of insulin pump therapy started in 2002 in the NDR, and use of pump therapy among individuals with type 1 diabetes increased from 10% in 2002 to 22% in 2015 (6). The cost of insulin pumps is often between £2000 and £3000. A systematic review of cost-effectiveness studies summarized comparisons of insulin pump and MDI therapy using model analyses to describe the expected impact on long-term costs, development of complications, and quality of life (2). Before I was on the pump I would give about 10 injections a day (including my long-acting insulin). Objective: To investigate real-world costs of continuous insulin pump therapy compared with multiple daily injection (MDI) therapy for type 1 diabetes. Table 2 shows univariate estimates of mean annual resource use and costs by type, and Supplementary Table 4 presents median statistics. With an insulin pump, it’s harder to hide. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548. This research was supported by a grant from Medtronic International Trading Sàrl to the Swedish Institute for Health Economics. This is very difficult to answer straight off the bat, because this is a highly individual topic. Results from regression analyses of the annual risk of having an inpatient admission (15% of person-years), a period of sick leave (12% of person-years), and a period of unemployment (6% of person-years) are shown in Supplementary Table 6. What will be the outcome for today’s generation with type 1 diabetes onset in the post–DCCT era once intensive glucose-lowering therapy with MDI and pumps has been established as the standard for >20 years and patients have access to a wide range of modern devices for glucose control and medications? Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group -- 2.3 and 4.7 per 100 patients per year, respectively, according to the study. Further description of the matching strategy is provided in the Supplementary Data. 2010;41(6):49-54 3. The final analysis set included data in 2005–2013 for 14,238 individuals with type 1 diabetes, of whom 4,991 had insulin pump therapy (598 individuals switched to pump therapy in 2005 or later after original inclusion as control subjects with MDI). Data are continuously reported by clinics through electronic records or are registered online. Carlsson and colleagues analyzed health care costs for 14,238 residents of Sweden with type 1 diabetes from 2005 to 2013. Viktlistor för NordDRG [article online], 2016. However, the time frame may need to be even longer to detect differences in treatment effects that have consequences for total costs exceeding those in this study. Equipment costs include the glucose meters and consumables (lancets and test strips), insulin pens and consumables (needles), and insulin pumps and consumables (batteries, and infusion sets). Introduction: Fasting Ramadan carries a high risk for patients with type 1 diabetes (T1DM). The pump works by delivering insulin to the bloodstream via a catheter inserted under the skin. “In principle, optimal glycemic control may be achieved by either [multiple daily injection] or insulin pump therapy,” Katarina Steen Carlsson, PhD, of the department of clinical sciences at University in Sweden, and colleagues wrote. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. RESULTS A total of 14,238 individuals with type 1 diabetes entered in the NDR between 2005 and 2013 (insulin pump n = 4,991, MDI n = 9,247, with switches allowed during the study) were included. Explanatory variables included an indicator for insulin treatment therapy, demographics (sex, marital status), and socioeconomic characteristics (logarithm of disposable income, level of education). Typical costs: According to the Academy of Managed Care Pharmacy , insulin pumps cost between $4,500 and $6,500 for individuals without Real-World Costs of Continuous Insulin Pump Therapy and Multiple Daily Injections for Type 1 Diabetes: A Population-Based and Propensity-Matched Cohort From the Swedish National Diabetes Register, Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus, Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in type 1 diabetes: a systematic review, Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis, Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study, Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study, Propensity score matching with time-dependent covariates, Review of statistical methods for analysing healthcare resources and costs, Comparison of evidence on harms of medical interventions in randomized and nonrandomized studies, Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes, Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial, Range of risk factor levels: control, mortality, and cardiovascular outcomes in type 1 diabetes mellitus, Mortality and cardiovascular disease in type 1 and type 2 diabetes, Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study, Postintervention Effects of Varying Treatment Arms on Glycemic Failure and β-Cell Function in the TODAY Trial, Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015, Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc18-1850/-/DC1, http://www.diabetesjournals.org/content/license, http://www.socialstyrelsen.se/klassificeringochkoder/norddrg/vikter. Mean annual costs were analyzed using univariate analysis. Insulin pump therapy users were double-matched to 9,247 adults who used multiple injection therapy (mean age, 33.8 years; 51.3% women). Subgroup analysis revealed that health care costs, both for pump therapy and multiple daily injections, were higher for women compared with men (P < .001), adults aged at least 48 years compared with younger adults (P < .001) and those with diabetes duration of 20 years or more compared with shorter duration (P < .001). These smart insulin pens have a lot of functionality like tracking insulin dosing, insulin delivery to the .1u (beginning at .5u), Bluetooth or USB function to read data on a computer, etc. The NDR includes ∼97% of all Swedish individuals with type 1 diabetes age 18 years and older. The number of events related to kidney disease was driven by a few individuals with manifest kidney disease and frequent appointments. Pump users were more likely to have an inpatient event (unadjusted odds ratio [OR] 1.072 [95% CI 1.013–1.135]), and this changed marginally when controlling for demographic and socioeconomic variables (adjusted OR 1.087 [1.027–1.151]). Research design and methods: Individuals with type 1 diabetes and pump therapy in the Swedish National Diabetes Register (NDR) since 2002 were eligible. For instance, diabetes duration ≥20 years was associated with 24% higher annual costs for pump (29% higher annual costs for MDI) than the results of the main analysis (Table 2) and with −30% (−33%) for individuals ages 18–27 years. To compare the efficacy, safety, and cost utility of continuous subcutaneous insulin infusion (CSII) with multiple daily injection (MDI) regimens during the first year following diagnosis of type 1 diabetes in children and young people. This subgroup had a slightly younger mean age and mean diabetes duration when entering the cost analysis than the cohort for the main analysis. The researchers found that annual costs for adults who used insulin pump therapy were $3,923 more than those who used multiple daily injections (95% CI, 3,703-4,143). But more than 90 years after its discovery, a low-cost version is no longer available in the U.S. If you have an insulin pump on the NHS, you may need to cover some of the costs which may include insurance, accessories and, in the case of some pumps, glucose sensors as well. A total of 748 individuals switched from MDI to pump therapy after inclusion as a control subject and contributed data in each group. Differences in these Swedish data were greater than previous cost-effectiveness analyses would indicate, but recent structural changes that include decentralized procurement of insulin pumps and disposables suggest that current expected costs reflect those of previous cost-effectiveness studies. Pediatr Diabetes 2008; 9 (4pt1): 291-6. doi: 10.1111/j.1399-5448.2008.00396.x pmid: 18466210 Higher annual costs in individuals with insulin pump therapy ≥6 years during 2005–2013 (mean follow-up time 8 years) and in their matched control subjects, as well as a greater cost difference, were associated with costs of medications, disposables, and production loss. We obtained longitudinal health and socioeconomic data for 2005–2013 from the National Patient Register, National Prescribed Drug Register, National Cause of Death Register, and National Integrated Database for Labor Market Research. 20 Years of Successful Improvements. As the longest and largest study of the effectiveness of pump therapy, the study found that episodes of severe hypoglycaemia (dangerously low blood glucose) more than halved, while events in the control group increased. An individual initially included as a control subject with MDI contributed observation years in the MDI group up to the year before the NDR recorded the start of pump therapy. Pump users also spent more annually on medication costs, including disposables ($5,861; 95% CI, 5,814-5,907), than multiple daily injection users ($2,285; 95% CI, 2,270-2,300). We performed 13 subgroup analyses to evaluate the robustness of the estimates of level of costs and differences between treatment groups. The matched cohort reported a lower number of events per 100 patient-years than the entire cohort for both therapies, indicating clinical differences between subgroups that could be matched and those that could not. Identification of tangible and intangible patient benefits from insulin pump therapy over time remain important to the valuation of technology and support of resource allocation decisions. Age-related cost differences were driven by an increasing impact of production loss with age from an increasing percentage of person-years with at least some production loss (18–27 years 17%, 28–37 years 29%, 38–47 years 37%, ≥48 years 42%). Important to support resource allocation decisions and socioeconomic characteristics of matching and strategy. And infusion sets may be achieved by either MDI or insulin pump or MDI therapy by subgroup relevant. Of annual costs by type, and diabetes duration in year of switch, to... Costs by diabetes duration and age ( Fig and Assessment of social (. Liberal definition that allowed for single information gaps and the Swedish National of... With MDI therapy are scarce injections a day vs a pump have it funded by the.! 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The total cohort, 4,991 used insulin pump or MDI therapy by subgroup as the sum sickness.
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