Wood Jamie R, Moreland Elaine C, Volkening Lisa K, Svoren Britta M, Butler Deborah A, Laffel Lori M B
Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA.
Diabetes Care. 2006 Nov;29(11):2355-60. doi: 10.2337/dc06-1141.
To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy.
We followed a cohort of youth with type 1 diabetes (n = 161) starting the pump between 1998 and 2001 and recorded natural history of treatment.
At pump start, patients (71% female) had a mean age of 14.1 +/- 3.7 years, diabetes duration of 7.1 +/- 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 +/- 1.2, a daily insulin dose of 1.0 +/- 0.3 units/kg, and an HbA(1c) (A1C) of 8.4 +/- 1.4%. After 1 year, mean daily BGM frequency was 4.5 +/- 1.7, daily insulin dose was 0.8 +/- 0.2 units/kg, and A1C was 8.1 +/- 1.3% (all baseline versus 1-year data, P < 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 +/- 2.9 years after a mean duration of pump use of 2.1 +/- 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P < 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P = 0.04) and at the most recent clinic visit (P = 0.01).
After an average of 3.8 years, >80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes.
研究一组开始胰岛素泵治疗的青少年患者的纵向治疗结果、停药率及原因，以及胰岛素泵治疗成功的预测因素。
我们追踪了一组于1998年至2001年间开始使用胰岛素泵的1型糖尿病青少年患者（n = 161），并记录其治疗的自然病程。
开始使用胰岛素泵时，患者（71%为女性）的平均年龄为14.1±3.7岁，糖尿病病程为7.1±4.0年，每日血糖监测（BGM）频率为4.0±1.2次，每日胰岛素剂量为1.0±0.3单位/千克，糖化血红蛋白（HbA1c）（A1C）为8.4±1.4%。1年后，平均每日BGM频率为4.5±1.7次，每日胰岛素剂量为0.8±0.2单位/千克，A1C为8.1±1.3%（所有基线数据与1年数据相比，P < 0.01）。截至2005年，29名患者（18%）在平均使用胰岛素泵2.1±1.3年后，于平均年龄17.0±2.9岁时恢复注射治疗。恢复注射治疗的患者在基线和1年时的BGM频率显著更低（P < 0.02）。此外，继续使用胰岛素泵的患者在1年时（P = 0.04）以及最近一次门诊就诊时（P = 0.01）的A1C均低于恢复注射治疗的患者。
平均3.8年后，超过80%的儿科患者维持胰岛素泵治疗且保持了基线A1C水平。与继续使用胰岛素泵的患者相比，停用胰岛素泵的患者依从性较差，未获得同等的血糖获益；这些患者需要持续的支持以提高依从性和治疗效果。
