Heptulla Rubina A, Allen Holley F, Gross Todd M, Reiter Edward O
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030-2399, USA.
Pediatr Diabetes. 2004 Mar;5(1):10-5. doi: 10.1111/j.1399-543X.2004.00035.x.
The aim of continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus (T1DM) is to mimic as closely as possible the normal physiologic pattern seen in individuals without diabetes. This study was undertaken to determine the specific areas of improved glycemic control in subjects after initiation of insulin pump therapy and times where further improvement is needed.
Eight patients with T1DM (age 7.5-17 yr) wore the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA, USA) for 3 d before and 3 months after initiation of insulin pump therapy. The CGMS, which measures inter- stitial glucose concentrations every 5 min for a 72-h period, was used to evaluate glucose profiles. Patients entered 4-5 fingerstick blood glucose measurements daily into the sensor for calibration. Detailed logs of food intake, exercise, and hypoglycemic symptoms were also recorded.
Hemoglobin A1c (HbA1C) was reduced (p < 0.007) following 3 months of insulin pump therapy. Post-CSII continuous glucose profiles demonstrated an overall improvement in hourly mean glucose over a 24-h period (p < 0.001) as well as a reduction in the area under the curve for glucose (27 +/- 4 prepump vs. 8.6 +/- 1.4 mg/dL/d postpump, p < 0.004). This improvement was a result of an attenuation of the maximal postprandial glycemic excursions. Postbreakfast 349 +/- 24 vs. 267 +/- 16 mg/dL, p < 0.003; lunch 340 +/- 16 vs. 217 +/- 20 mg/dL, p < 0.003. Postdinner average similarly decreased after 3 months of CSII by 22%, p < 0.04.
Pump therapy specifically improved the postprandial glucose excursions in children.
1型糖尿病（T1DM）患者持续皮下胰岛素输注（CSII）治疗的目的是尽可能模拟无糖尿病个体的正常生理模式。本研究旨在确定胰岛素泵治疗开始后受试者血糖控制改善的具体方面以及需要进一步改善的时间点。
8例T1DM患者（年龄7.5 - 17岁）在胰岛素泵治疗开始前3天和开始后3个月佩戴持续葡萄糖监测系统（CGMS）（美敦力MiniMed，美国加利福尼亚州北岭）。CGMS每5分钟测量一次组织间液葡萄糖浓度，为期72小时，用于评估血糖谱。患者每天输入4 - 5次指尖血糖测量值用于传感器校准。还记录了详细的食物摄入、运动和低血糖症状日志。
胰岛素泵治疗3个月后糖化血红蛋白（HbA1C）降低（p < 0.007）。CSII治疗后连续血糖谱显示24小时内每小时平均血糖总体改善（p < 0.001），以及葡萄糖曲线下面积减少（泵治疗前27 ± 4 vs. 泵治疗后8.6 ± 1.4 mg/dL/d，p < 0.004）。这种改善是餐后最大血糖波动减弱的结果。早餐后349 ± 24 vs. 267 ± 16 mg/dL，p < 0.003；午餐后340 ± 16 vs. 217 ± 20 mg/dL，p < 0.003。晚餐后平均值在CSII治疗3个月后同样下降了22%，p < 0.04。
泵治疗特别改善了儿童餐后血糖波动。
