Babar Ghufran S, Ali Omar, Parton Elaine A, Hoffmann Raymond G, Alemzadeh Ramin
Children's Hospital of Wisconsin Diabetes Center and Sections of Pediatric Endocrinology & Metabolism and Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Diabetes Technol Ther. 2009 Mar;11(3):131-7. doi: 10.1089/dia.2008.0042.
BACKGROUND/AIMS: Continuous subcutaneous insulin infusion (CSII) is a safe and effective alternative to insulin injections in pediatric type 1 diabetes mellitus. CSII can be associated with an increased risk of hypoglycemia and diabetic ketoacidosis (DKA) in some patients. In our Center, patients/guardians are screened for proficiency in diabetes management skills as a prerequisite to initiation of CSII. We reviewed the clinical data from our patients to assess the predictors associated with nonadherence to CSII therapy.
We retrospectively collected clinical data on all our CSII initiations between July 1999 to June 2003, including: body mass index, hemoglobin A1c (HbA1c), total daily dose, bolus to basal insulin ratio, hypoglycemic episodes (blood glucose <60 mg/dL/week), mean fasting self-monitored blood glucose (SMBG), severity of lipohypertrophy, DKA, and pubertal status.
Forty-six patients 9.90 +/- 3.4 years old (28 girls and 18 boys) started CSII in the 4-year period. While 39 patients (85%) 9.8 +/- 3.5 years old currently remain on CSII, seven patients (15%) 11.2 +/- 0.9 years old discontinued CSII. Fifteen patients (32.6%) were prepubertal at CSII initiation, and none discontinued CSII in this cohort, whereas seven of 31 (22.6%) pubertal patients discontinued CSII. The patients who continued CSII were similar to the CSII-discontinued cohort at baseline. At 12 months, rising HbA1c was the only predictor of future nonadherence to CSII. At 24 months, the discontinuation group had higher mean fasting SMBG levels and severe lipohypertrophy (P < 0.05). None of the prepubertal patients discontinued CSII, while all seven patients (100%) in the CSII-discontinued group were pubertal (P < 0.001).
Extensive screening by a multidisciplinary diabetes team prior to initiation of CSII regimen results in relatively lower discontinuation rates and a higher chance of maintaining optimal glycemic control (HbA1C < 8%) compared to previous studies.
背景/目的：持续皮下胰岛素输注（CSII）是1型糖尿病患儿胰岛素注射的一种安全有效的替代方法。在一些患者中，CSII可能会增加低血糖和糖尿病酮症酸中毒（DKA）的风险。在我们中心，作为启动CSII的前提条件，会对患者/监护人进行糖尿病管理技能熟练程度的筛查。我们回顾了患者的临床数据，以评估与不坚持CSII治疗相关的预测因素。
我们回顾性收集了1999年7月至2003年6月期间所有启动CSII患者的临床数据，包括：体重指数、糖化血红蛋白（HbA1c）、每日总剂量、基础胰岛素与大剂量胰岛素比例、低血糖发作次数（血糖<60mg/dL/周）、平均空腹自我监测血糖（SMBG）、脂肪增生严重程度、DKA和青春期状态。
在这4年期间，46例年龄为9.90±3.4岁（28例女孩和18例男孩）的患者开始了CSII治疗。目前，39例年龄为9.8±3.5岁的患者（85%）仍在接受CSII治疗，7例年龄为11.2±0.9岁的患者（15%）停止了CSII治疗。15例患者（32.6%）在开始CSII治疗时未进入青春期，该队列中无人停止CSII治疗，而31例青春期患者中有7例（22.6%）停止了CSII治疗。继续接受CSII治疗的患者在基线时与停止CSII治疗的队列相似。在12个月时，HbA1c升高是未来不坚持CSII治疗的唯一预测因素。在24个月时，停止治疗组的平均空腹SMBG水平更高，脂肪增生更严重（P<0.05）。未进入青春期的患者中无人停止CSII治疗，而停止CSII治疗组的所有7例患者（100%）均处于青春期（P<0.001）。
与以往研究相比，在启动CSII治疗方案之前，由多学科糖尿病团队进行广泛筛查可使停药率相对较低，维持最佳血糖控制（HbA1C<8%）的机会更高。
