1 Children's Mercy Hospital and University of Missouri-Kansas City , Kansas City, Missouri.
Diabetes Technol Ther. 2015 Jan;17(1):21-8. doi: 10.1089/dia.2014.0139.
Multicenter long-term studies of predictors for the effectiveness of continuous subcutaneous insulin infusion (CSII) in clinical practice are lacking. We hypothesized that there are substantially greater reductions in hemoglobin A1c (HbA1c) in patients with poor glycemic control and that other predictors may also exist.
We used data from 10 outpatient diabetic clinics in Sweden and studied CSII treatment over 5 years. Patients with HbA1c values available ≤ 6 months before starting CSII and at 5 years were included (n = 272, 82% of CSII patients) along with 2,437 contemporaneous controls on multiple daily insulin injections (MDI). Baseline variables evaluated were age, sex, diabetes duration, insulin dose, body mass index (BMI), HbA1c at baseline, and outpatient clinical care unit.
At 5 years, significantly greater reductions in HbA1c by CSII compared with MDI were found for patients with higher baseline HbA1c (P = 0.032) and lower baseline BMI (P = 0.013). For baseline HbA1c levels of 7.0%, 8.0%, and 9.0% and a BMI of 25 kg/m(2), the reduction in HbA1c level by CSII was 0.08% (difference not significant), 0.16% (95% confidence interval, 0.03-0.29%), and 0.25% (95% confidence interval, 0.11-0.39%), respectively. Corresponding analyses for the change in HbA1c level from start to 1 and 2 years revealed a significant interaction of insulin pump therapy only with baseline HbA1c levels (P < 0.001 and P = 0.030, respectively). The interaction term between outpatient clinical care unit and CSII treatment was statistically significant for some care units, with some care units demonstrating a benefit from CSII and others demonstrating a detriment.
Patients with high HbA1c levels have a greater probability of improved HbA1c after initiating pump therapy, but effects remain relatively modest even for patients with poor control. Factors predicting successful insulin pump use need further study.
在临床实践中，缺乏关于持续皮下胰岛素输注（CSII）有效性的预测因素的多中心长期研究。我们假设，血糖控制较差的患者的血红蛋白 A1c（HbA1c）降低幅度更大，并且可能存在其他预测因素。
我们使用了瑞典 10 家门诊糖尿病诊所的数据，并研究了 CSII 治疗 5 年的情况。纳入了在开始 CSII 治疗前≤6 个月和 5 年时 HbA1c 值可用的患者（n=272，占 CSII 患者的 82%），并纳入了同时接受多次胰岛素注射（MDI）的 2437 名对照患者。评估的基线变量包括年龄、性别、糖尿病病程、胰岛素剂量、体重指数（BMI）、基线时的 HbA1c 和门诊临床护理单位。
与 MDI 相比，CSII 在基线 HbA1c 较高（P=0.032）和基线 BMI 较低（P=0.013）的患者中 HbA1c 降低幅度显著更大。对于基线 HbA1c 水平为 7.0%、8.0%和 9.0%和 BMI 为 25kg/m2，CSII 降低 HbA1c 水平分别为 0.08%（差异无统计学意义）、0.16%（95%置信区间，0.03-0.29%）和 0.25%（95%置信区间，0.11-0.39%）。从开始到 1 年和 2 年的 HbA1c 水平变化的相应分析显示，胰岛素泵治疗仅与基线 HbA1c 水平存在显著的交互作用（P<0.001 和 P=0.030）。门诊临床护理单位和 CSII 治疗之间的交互项在一些护理单位具有统计学意义，一些护理单位从 CSII 中获益，而其他护理单位则受损。
HbA1c 水平较高的患者在开始泵治疗后 HbA1c 改善的可能性更大，但即使是血糖控制较差的患者，效果仍然相对较小。预测胰岛素泵使用成功的因素需要进一步研究。
