Walsh John, Roberts Ruth, Bailey Timothy
Advanced Metabolic Care and Research, Escondido, California 92026, USA.
J Diabetes Sci Technol. 2010 Sep 1;4(5):1174-81. doi: 10.1177/193229681000400516.
Successful insulin pump therapy depends on correct insulin doses based on an optimal total daily dose (TDD) and optimal pump settings for basal infusion, carbohydrate factor (CarbF), and glucose correction factor (CorrF) based on the TDD. There are limited data in the literature to guide providers and patients regarding methods to optimize these critical parameters for glucose control.
Anonymous data downloads from 1020 insulin pumps used throughout the United States and overseen by a variety of clinicians were analyzed retrospectively to find insulin doses that provided the best glucose control. A subset of 396 pumps was chosen for glucose data reliability, with over 85% of their glucose data directly entered from a meter. This subset was divided into tertiles based on glucose levels, and the low glucose tertile was analyzed to derive formulas for optimal insulin pump settings.
An inconsistent clustering of pump settings was found for the CarbF and the CorrF. This was less pronounced when CarbFs and CorrFs were determined from the actual bolus doses delivered once adjustments were made to the initial dose calculations by users and, to a larger extent, internally by the bolus calculator itself. Common beliefs that hyperglycemia is related to less carb counting, fewer carb boluses, or delivery of less insulin per day were not substantiated in this data. New or verified insulin dosing formulas presented include basal U/day = TDD × 0.48; CarbF = [2.6 × Wt(lb)]/TDD; and CorrF = 1960/TDD.
Insulin pump users cannot reap full benefit from their pump bolus calculator if the settings on which bolus doses are based are less than optimal. Our data show that CarbFs and CorrFs tend to be unevenly distributed, suggesting that these factors are not selected in a systematic manner through use of formulas. Poor glucose outcomes among insulin pump users appear to be related to pump setting errors and being relatively underinsulinized, even though those in poor control use more total insulin per day. We have developed a model with the hypothesis that improved glucose outcomes will result from the use of formulas to derive appropriate pump settings. Prospective validation of these concepts is needed.
胰岛素泵治疗的成功取决于基于最佳每日总剂量（TDD）的正确胰岛素剂量，以及基于TDD的基础输注、碳水化合物系数（CarbF）和血糖校正系数（CorrF）的最佳泵设置。文献中关于指导医护人员和患者优化这些血糖控制关键参数方法的数据有限。
回顾性分析从美国各地使用的1020台胰岛素泵中匿名下载的数据，这些泵由不同的临床医生监管，以找出能提供最佳血糖控制的胰岛素剂量。选择了396台泵的子集用于评估血糖数据的可靠性，其中超过85%的血糖数据是直接从血糖仪输入的。该子集根据血糖水平分为三分位数，对低血糖三分位数进行分析以得出最佳胰岛素泵设置的公式。
发现CarbF和CorrF的泵设置聚类不一致。当用户对初始剂量计算进行调整后，根据实际输注剂量确定CarbF和CorrF时，这种不一致不太明显，并且在很大程度上，由输注计算器本身在内部进行调整时也是如此。高血糖与较少的碳水化合物计数、较少的碳水化合物输注或每天输注较少胰岛素有关的普遍观点在这些数据中未得到证实。给出的新的或经过验证的胰岛素给药公式包括：基础胰岛素用量（U/天）=TDD×0.48；CarbF = [2.6×体重（磅）]/TDD；CorrF = 1960/TDD。
如果输注剂量所基于的设置不理想，胰岛素泵使用者就无法从其泵输注计算器中获得全部益处。我们的数据表明，CarbF和CorrF往往分布不均，这表明这些因素并非通过使用公式以系统的方式选择。胰岛素泵使用者血糖控制不佳似乎与泵设置错误以及胰岛素相对不足有关，尽管控制不佳的患者每天使用的胰岛素总量更多。我们已经建立了一个模型，其假设是使用公式得出合适的泵设置将改善血糖控制结果。需要对这些概念进行前瞻性验证。
