The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Diabetes. 2011 Aug;12(5):506-12. doi: 10.1111/j.1399-5448.2010.00701.x. Epub 2010 Aug 15.
There are few reports on rates and predictors for pump discontinuation in the pediatric population.
To study the rate of and predictors for insulin pump discontinuation among pediatric patients with type 1 diabetes.
Medical chart review of 530 patients with type 1 diabetes who had started pump therapy between 2000 and 2008 in our center revealed that 11.3% had discontinued pump use after 3 d to 5 yr; of these, 9.1% discontinued pump use at least 3 months after initiation. Relevant data were retrieved from the files of these patients and from those of 100 randomly assigned pump-treated patients.
The pump discontinuation group had a significantly higher proportion of female patients (75 vs. 46%, p = 0.001) and patients above 10 yr of age (93.8 vs. 80%, p = 0.03) than the reference group. Comparable findings were noted for age at diagnosis, pubertal stage, anthropometric data and duration of diabetes at pump initiation, rate of severe hypoglycemic and diabetic ketoacidosis episodes. There were no between-group differences in number of daily insulin injections and blood glucose measurements before pump treatment. At pump initiation, HbA(1c) was significantly higher in patients discontinuing pump therapy than in the controls (8.6 ± 1.4 vs. 8.1 ± 1.0, p = 0.02). This difference was maintained at the last follow-up visit recorded.
Almost 90% of our cohort maintained pump therapy. Female gender, age older than 10 years in girls and poor metabolic control at pump initiation were associated with higher risk for pump discontinuation - for such patients intensified individual and family support may serve to maximize persistent pump therapy.
关于儿科人群中泵停止使用的发生率和预测因素的报告较少。
研究 1 型糖尿病患儿胰岛素泵停止使用的发生率和预测因素。
对 2000 年至 2008 年期间在我们中心开始使用泵治疗的 530 例 1 型糖尿病患者的病历进行回顾性分析，结果显示 11.3%的患者在使用泵 3 天至 5 年后停止使用泵；其中 9.1%的患者在开始使用泵至少 3 个月后停止使用泵。从这些患者的档案和随机选择的 100 例接受泵治疗的患者的档案中检索到相关数据。
与对照组相比，泵停止使用组的女性患者比例（75%比 46%，p = 0.001）和 10 岁以上的患者比例（93.8%比 80%，p = 0.03）显著更高。两组在诊断时的年龄、青春期阶段、人体测量数据以及开始使用泵时糖尿病的持续时间、严重低血糖和糖尿病酮症酸中毒发作的发生率方面也存在类似的发现。两组在开始使用泵之前的每日胰岛素注射次数和血糖测量次数方面无差异。在开始使用泵时，停止使用泵治疗的患者的 HbA1c 显著高于对照组（8.6±1.4比 8.1±1.0，p = 0.02）。在记录的最后一次随访中，这种差异仍然存在。
我们的队列中几乎 90%的患者仍在使用泵。女性、女孩年龄大于 10 岁以及开始使用泵时的代谢控制不佳与更高的泵停止使用风险相关-对于这些患者，加强个体化和家庭支持可能有助于最大限度地维持持续使用泵治疗。
