Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas 72202, USA.
Diabetes Technol Ther. 2011 Oct;13(10):1023-30. doi: 10.1089/dia.2011.0085. Epub 2011 Jun 30.
In the interest of preserving residual insulin secretory capacity present at the time of diagnosis with type 1 diabetes (T1D), we compared the efficacy of starting insulin pump therapy at diagnosis with standard multiple daily insulin injections (MDIs).
We conducted a prospective, randomized, pilot trial comparing MDI therapy with continuous subcutaneous insulin therapy (pump therapy) in 24 patients, 8-18 years old, with newly diagnosed T1D. Subjects were evaluated at enrollment and 1, 3, 6, 9, and 12 months after initial diagnosis of T1D. Preservation of insulin secretion, measured by mixed-meal-stimulated C-peptide secretion, was compared after 6 and 12 months of treatment. Between-group differences in glycosylated hemoglobin (HbA1c), continuous glucose sensor data, insulin utilization, anthropometric measures, and patient satisfaction with therapy were also compared at multiple time points.
Initiation of pump therapy within 1 month of diagnosis resulted in consistently higher mixed-meal tolerance test-stimulated C-peptide values at all time points, although these differences were not statistically significant. Nonetheless, improved glycemic control was observed in insulin pump-treated subjects (more time spent with normoglycemia, better mean HbA1c), and pump-treated subjects reported comparatively greater satisfaction with route of treatment administration.
Initiation of insulin pump therapy at diagnosis improved glycemic control, was well tolerated, and contributed to improved patient satisfaction with treatment. This study also suggests that earlier use of pump therapy might help to preserve residual β-cell function, although a larger clinical trial would be required to confirm this.
为了保留 1 型糖尿病（T1D）诊断时尚存的胰岛素分泌能力，我们比较了在诊断时开始胰岛素泵治疗与标准多次每日胰岛素注射（MDI）的疗效。
我们进行了一项前瞻性、随机、初步试验，比较了 MDI 治疗与连续皮下胰岛素治疗（泵治疗）在 24 例 8-18 岁新诊断为 T1D 的患者中的疗效。患者在入组时以及 T1D 诊断后 1、3、6、9 和 12 个月进行评估。在治疗 6 个月和 12 个月后，通过混合餐刺激 C 肽分泌来比较胰岛素分泌的保留情况。还比较了治疗组间糖化血红蛋白（HbA1c）、连续血糖传感器数据、胰岛素利用、人体测量指标和患者对治疗的满意度的差异。
在诊断后 1 个月内开始使用泵治疗，在所有时间点均导致混合餐耐量试验刺激的 C 肽值持续升高，尽管这些差异无统计学意义。尽管如此，胰岛素泵治疗组的血糖控制得到改善（更多时间处于正常血糖水平，HbA1c 平均值更好），并且泵治疗组患者对治疗给药途径的满意度更高。
在诊断时开始胰岛素泵治疗可改善血糖控制，且耐受性良好，并有助于提高患者对治疗的满意度。本研究还表明，更早使用泵治疗可能有助于保留残余β细胞功能，尽管需要更大的临床试验来证实这一点。
