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现代临床管理有助于减轻儿童 1 型糖尿病的影响。

Modern clinical management helps reducing the impact of type 1 diabetes in children.

机构信息

Department of Pediatrics, Azienda Ospedaliera, University of Milan, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20154 Milan, Italy.

Department of Pediatrics, University of Milano, "Ospedale dei Bambini V. Buzzi", via Castelvetro 32, 20154 Milan, Italy.

出版信息

Pharmacol Res. 2015 Aug;98:16-21. doi: 10.1016/j.phrs.2015.03.001. Epub 2015 Mar 14.

Abstract

Type 1 diabetes care may be very costly not only in terms of money but also in terms of psychological and therapeutic acceptance and compliance. Recently, a lot of new technologies have been introduced in the care of patients with type 1 diabetes that should allow them to achieve an improvement in glycemic control, quality of life and above all prevent long-term complications. Combining continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) provides a more useful tool for patients with type 1 diabetes, the sensor-augmented pump (SAP). The aim of the present review is to explore SAP efficacy and safety in young patients with type 1 diabetes. SAP demonstrated increased efficacy in lowering glycated hemoglobin when compared either to multiple daily injections or CSII alone. Its efficacy is positively associated with CGM use, baseline HbA1c and patients' age. According to currently available evidence, SAP seems sufficiently safe, effective and beneficial in improving glycemic control in pediatric patients with type 1 diabetes. Moreover, encouraging results using semi-closed loop systems are emerging, paving the way toward a fully automated artificial pancreas. As pediatric diabetologists we have the duty to offer our patients the best therapeutic option currently available, supported by evidence, to help them gain the best results with the fewest adverse effects (hypoglycemia and/or diabetic ketoacidosis), better if chomping a little piece of dark chocolate.

摘要

1 型糖尿病的护理不仅在经济方面,而且在心理和治疗的接受和依从性方面都可能非常昂贵。最近,许多新技术已被引入 1 型糖尿病患者的护理中,这些技术应能改善血糖控制、生活质量,最重要的是预防长期并发症。连续血糖监测 (CGM) 和连续皮下胰岛素输注 (CSII) 的结合为 1 型糖尿病患者提供了更有用的工具,即传感器增强型泵 (SAP)。本综述的目的是探讨 SAP 在年轻 1 型糖尿病患者中的疗效和安全性。与多次皮下注射或 CSII 相比,SAP 在降低糖化血红蛋白方面更有效。其疗效与 CGM 的使用、基线 HbA1c 和患者年龄呈正相关。根据目前的证据,SAP 在改善儿科 1 型糖尿病患者的血糖控制方面似乎是足够安全、有效和有益的。此外,正在出现使用半闭环系统的令人鼓舞的结果,为全自动人工胰腺铺平了道路。作为儿科内分泌学家,我们有责任为患者提供目前最有效的治疗选择,支持证据,帮助他们获得最佳结果,同时尽量减少不良影响(低血糖和/或糖尿病酮症酸中毒),如果能咬一口黑巧克力就更好了。

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