Levy-Shraga Y, Lerner-Geva L, Modan-Moses D, Graph-Barel C, Mazor-Aronovitch K, Boyko V, Pinhas-Hamiel O
Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Israel.
Exp Clin Endocrinol Diabetes. 2013 Apr;121(4):225-9. doi: 10.1055/s-0032-1331698. Epub 2013 Jan 17.
The incidence of type 1 diabetes mellitus (T1DM) in young children has increased considerably over recent years. The purpose was to examine the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) therapy in preschool children with T1DM.
A retrospective chart review of 113 children diagnosed with T1DM while younger than age 6 years. Mean age at diagnosis was 3.5±1.5 years and mean duration of follow 9.7±7.0 years. Patients were divided into 3 groups. Group1 initiated CSII therapy before the age of 6 years (n=26), Group 2 was treated with multiple daily injections (MDI) throughout follow-up (n=34), and Group 3 initiated CSII after age 6 (n=53). Metabolic control was assessed by HbA1C levels and safety by rates of severe hypoglycemia and diabetic ketoacidosis (DKA) events.
In Group 1, the highest mean HbA1C value (8.5%) was observed 1-2 years prior to CSII initiation. During the 5 year period following CSII initiation, mean HbA1C levels ranged between 7.4 and 8.0%. Throughout the entire follow-up period, mean HbA1C levels were lower for Group 1 than Group 2 (p=0.05). In Group 3, mean HbA1C level decreased from 8.7% pre-CSII to 8.3% post-CSII (p<0.001). Nevertheless HbA1C levels remained higher than for those who started pump therapy before age 6 (p=0.02).
Our study demonstrated better metabolic control in pre-school children treated with CSII compared to those treated with MDI. This benefit sustained for 5 years after CSII initiation and was not accompanied by increased risk of severe hypoglycemia or DKA events.
近年来，幼儿1型糖尿病（T1DM）的发病率显著上升。本研究旨在探讨持续皮下胰岛素输注（CSII）疗法对学龄前T1DM儿童的有效性和安全性。
对113例6岁前确诊为T1DM的儿童进行回顾性病历分析。确诊时的平均年龄为3.5±1.5岁，平均随访时间为9.7±7.0年。患者分为3组。第1组在6岁前开始CSII治疗（n = 26），第2组在整个随访期间接受每日多次注射（MDI）治疗（n = 34），第3组在6岁后开始CSII治疗（n = 53）。通过糖化血红蛋白（HbA1C）水平评估代谢控制情况，通过严重低血糖和糖尿病酮症酸中毒（DKA）事件的发生率评估安全性。
在第1组中，CSII开始前1 - 2年观察到最高平均HbA1C值（8.5%）。在CSII开始后的5年期间，平均HbA1C水平在7.4%至8.0%之间。在整个随访期间，第1组的平均HbA1C水平低于第2组（p = 0.05）。在第3组中，平均HbA1C水平从CSII前的8.7%降至CSII后的8.3%（p < 0.001）。然而，HbA1C水平仍高于6岁前开始泵治疗的患者（p = 0.02）。
我们的研究表明，与接受MDI治疗的学龄前儿童相比，接受CSII治疗的儿童代谢控制更好。这种益处在CSII开始后持续了5年，且未伴随严重低血糖或DKA事件风险的增加。
