Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia.
Pediatr Diabetes. 2011 Sep;12(6):556-9. doi: 10.1111/j.1399-5448.2010.00740.x. Epub 2011 Apr 6.
INTRODUCTION/AIMS: Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth.
Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed.
Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p=0.001) and bolus event (p<0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p<0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p=0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors.
Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.
介绍/目的：许多年轻人通过持续皮下胰岛素输注（CSII）方案改善了血糖水平；然而，相当一部分人的血糖仍持续受益。我们的目的是评估代表性儿科患者人群中与 CSII 相关的行为的依从性，并确定可能影响青少年 HbA1c 的可改变行为。
分析了 100 例 1 型糖尿病青少年胰岛素泵设备上传的数据。
将推荐行为转化为日常自我管理的能力在年轻人中差异很大。平均推注频率为 6.1 次/天；然而，有 69/100 的患者每天输入的血糖值<4 次。HbA1c 每增加 1 个 BGL（p=0.001）和推注事件（p<0.001）就会降低 0.2%。餐时胰岛素遗漏很常见，并与 HbA1c 显著升高相关。平均而言，如果每两周错过≥4 次早餐胰岛素，HbA1c 会增加 1.0%（p<0.001）。如果每两周记录到≤2 次/d 的进餐时的推注次数，那么 HbA1c 会增加 0.8%（p=0.001）。年龄增长和 CSII 持续时间与推荐行为的依从性较差相关。
CSII 方案获得的血糖优势与 CSII 的使用方式密切相关。青少年中经常出现对 CSII 相关任务的依从性差的情况，限制了 CSII 在这些青少年中的疗效。
