Alemzadeh Ramin, Palma-Sisto Paola, Holzum M, Parton Elaine, Kicher J
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Diabetes Technol Ther. 2007 Aug;9(4):339-47. doi: 10.1089/dia.2006.0038.
BACKGROUND/AIMS: Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic instability and hypoglycemia while increasing quality of life compared to insulin injection regimens. To evaluate indices of glycemic control and impact on quality of life, we studied a group of preschool children with type 1 diabetes mellitus (DM) on CSII.
Fourteen patients (eight girls and six boys) 3.9 +/- 0.8 years old with DM duration of 2.0 +/- 0.8 years were transitioned from flexible multiple daily insulin (FMDI) (pre-meal aspart and bedtime glargine) to CSII. Patients were evaluated with hemoglobin A(1c) (HbA(1c)) and continuous glucose monitoring quarterly for 1 year. Mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE), and hypoglycemic events (blood glucose <60 mg/dL) were determined. Patients' parents completed quality of life [TNO-AZL Preschool Children Quality of Life (TAPQoL)] questionnaires for their children at baseline and 1.0 year.
The total daily insulin and the bolus:basal ratio did not change during CSII (0.72 +/- 0.21 vs. 0.74 +/- 0.16 U/kg/day and 2.1 +/- 0.61 vs. 2.40 +/- 0.58 U/kg/day, respectively). There was no change in HbA(1c) (8.0 +/- 0.50% vs. 7.8 +/- 0.40%) or frequency of hypoglycemia (moderate, 92.3 vs. 73.1 events/100 patient-years; severe, 22.5 vs. 17.5 events/100 patient-years). The MBG (213 +/- 94 vs. 185 +/- 79 mg/dL) and frequency (1.9 +/- 1.6 vs. 2.1 +/- 2.2) and duration (nocturnal, 135 +/- 141 vs. 120 +/- 103 min; total, 267 +/- 222 vs. 189 +/- 148 min) of hypoglycemic events did not decrease, whereas MAGE was reduced on CSII (210 +/- 31 vs. 168 +/- 22 mg/dL, P < 0.005). The quality of life subscales on the TAPQoL questionnaire did not change on CSII.
CSII improved glycemic instability without reducing HbA(1c) or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.
背景/目的：与胰岛素注射方案相比，持续皮下胰岛素输注（CSII）被认为可减少血糖波动和低血糖发生，同时提高生活质量。为评估血糖控制指标及其对生活质量的影响，我们对一组接受CSII治疗的1型糖尿病（DM）学龄前儿童进行了研究。
14例年龄为3.9±0.8岁、DM病程为2.0±0.8年的患者（8例女孩和6例男孩）从灵活的多次每日胰岛素注射（FMDI）（餐时门冬胰岛素和睡前甘精胰岛素）转换为CSII。患者每季度接受糖化血红蛋白（HbA1c）和持续葡萄糖监测，为期1年。测定平均血糖（MBG）、血糖波动幅度平均值（MAGE）和低血糖事件（血糖<60mg/dL）。患者家长在基线和1.0年时为孩子填写生活质量问卷[TNO-AZL学龄前儿童生活质量问卷（TAPQoL）]。
CSII期间每日胰岛素总量和 bolus：基础胰岛素比例未发生变化（分别为0.72±0.21 vs. 0.74±0.16U/kg/天和2.1±0.61 vs. 2.40±0.58U/kg/天）。HbA1c无变化（8.0±0.50% vs. 7.8±0.40%），低血糖发生频率也无变化（中度，92.3 vs. 73.1次/100患者年；重度，22.5 vs. 17.5次/100患者年）。MBG（213±94 vs. 185±79mg/dL）、低血糖事件发生频率（1.9±1.6 vs. 2.1±2.2）和持续时间（夜间，135±141 vs. 120±103分钟；总计，267±222 vs. 189±148分钟）均未降低，而CSII治疗时MAGE降低（210±31 vs. 168±22mg/dL，P<0.005）。TAPQoL问卷中的生活质量子量表在CSII治疗时未发生变化。
CSII改善了血糖波动，但未降低HbA1c、低血糖事件发生频率和持续时间，也未改变家长对其孩子生活质量 的认知。CSII改善了血糖波动，是1型DM幼儿FMDI治疗的有效替代方案。
