Availability of insulin pump therapy in clinical practice.

AIM: To examine the availability of insulin pump therapy in patients with Type 1 diabetes. METHODS: Patients using insulin pumps among a cohort of 7224 patients with Type 1 diabetes were studied. RESULTS: In logistic regression, used to evaluate variables not changing over time among the total cohort, use of insulin pumps varied by outpatient clinic (P<0.001) and sex (P<0.001). Cox regression analysis in 5854 patients with detailed patient data prior to use of an insulin pump showed higher HbA(1c) (P<0.0001), lower creatinine (P=0.002), high and low insulin doses (P<0.0001), younger age (P<0.0001) and female sex (P<0.0001) to be associated with use of an insulin pump. Women were 1.5-fold more likely to start using an insulin pump (hazard ratio 1.52, 95% confidence interval 1.29-1.79) and patients in the 20- to 30-years age range were more than twice as likely to begin use of an insulin pump than patients aged 40-50 years (hazard ratio 8.63, 95% confidence interval 5.91-12.59 and hazard ratio 3.98, 95% confidence interval 2.80-5.64, respectively). A 10-µmol/l higher level of creatinine was associated with a hazard ratio of 0.56 (95% confidence interval 0.39-0.81) of starting use of an insulin pump. CONCLUSIONS: At 10 hospital outpatient clinics in Sweden, use of insulin pumps therapy varied by clinic. A higher proportion of women began using insulin pumps. Younger patients and patients with fewer complications were also more likely to start using an insulin pump. Further research is needed to confirm these findings in other geographical regions and to understand whether the availability of insulin pumps today is optimized.

Fetal heart rate pattern before and after paracervical anesthesia. A prospective study.

A prospective study of the fetal heart rate pattern during labor before and after paracervical blockade (PCB) was performed. The material comprised 469 women in labor, or 28% of 1673 women delivered during a 6-month period. The majority of the anesthesias (87%) were administered by specially trained midwives. Bupivacain (Marcain) was the anesthetic used. The injections were made at four different points at a cervical diameter of 3-9 cm. The concentration of the anesthetic was 0.25 or 1.25% generally in 10 ml of normal saline. A second PCB was administered in 54 patients at least one hour after the preceding one. Fetal heart rate (FHR) was recorded via a scalp electrode and the pattern studied 15 min before and 30 min after the injection of the anesthetic. Bradycardia was defined as a persistent deceleration exceeding 3 min and occurring within 30 min of the PCB. Variability and acceleration pattern persisted independently of the PCB. Following PCB, decelerations of all types increased, while the basal rhythm decreased by on average 1.5 beats/min. Following PCB fetal bradycardia occurred in 1.9%. The bradycardia persisted on average for 6.5 min with a lowest average FHR of 73 beats/min. Retrospectively, 6 out of 9 infants exhibited recognized risk factors for bradycardia. All infants with bradycardia scored 9-10/5 min, according to the Apgar rating scale and all had a normal development with regard to growth, motor and speech development at the age of 2 years. There were no significant differences in vaginal operative deliveries between the PCB and the non-PCB group.(ABSTRACT TRUNCATED AT 250 WORDS)