Wolf F M, Jacober S J, Wolf L L, Cornell R G, Floyd J C
Department of Postgraduate Medicine, University of Michigan, Ann Arbor 48109-0201.
J Clin Epidemiol. 1989;42(12):1129-36. doi: 10.1016/0895-4356(89)90110-8.
The impact of continuous subcutaneous insulin infusion (CSII) pump therapy on patients' activities of daily living and the prevalence of acute complications were examined in order to characterize patients' experience while on CSII, and to ascertain whether any of these factors could be associated with continued use of CSII. Fifty-one of 55 patients (93%) identified as initiating CSII in our medical center patient population completed retrospective surveys; 37 individuals (73%) were still using pumps and 14 individuals (27%) had discontinued pump use. CSII appeared to affect the quality of daily activities only modestly, neither improving nor interfering with many activities to any great degree. Activities associated with greatest improvements were eating, working, traveling, sleeping, and exercising. Results of logit analyses adjusting for duration of pump therapy indicated that the prevalence of six different acute complications (skin infections at the needle site, mild insulin reactions, more severe insulin reactions requiring assistance, hypoglycemic coma, asymptomatic hypoglycemia, and ketoacidosis) was not statistically associated with patients' decisions to continue or to stop CSII. In contrast, significant differences (p less than 0.05) between the groups continuing and discontinuing CSII were found in 11 of 18 activities of daily living. In general, patients continuing CSII, in contrast to those discontinuing CSII, found that many of their activities were improved significantly during pump therapy. There were few differences between groups in the degree to which CSII was perceived to interfere with daily activities. However, those continuing CSII found it significantly less necessary to take the pump off while doing some activities than did those discontinuing CSII.(ABSTRACT TRUNCATED AT 250 WORDS)
为了描述患者在持续皮下胰岛素输注（CSII）泵治疗期间的体验，并确定这些因素是否与继续使用CSII有关，研究了CSII泵治疗对患者日常生活活动及急性并发症发生率的影响。在我们医疗中心患者群体中，55名开始使用CSII的患者中有51名（93%）完成了回顾性调查；37人（73%）仍在使用泵，14人（27%）已停止使用泵。CSII似乎对日常活动质量的影响不大，对许多活动既没有很大改善也没有很大干扰。改善最大的活动包括饮食、工作、旅行、睡眠和锻炼。对泵治疗持续时间进行调整的logit分析结果表明，六种不同急性并发症（针头部位皮肤感染、轻度胰岛素反应、需要协助的更严重胰岛素反应、低血糖昏迷、无症状低血糖和酮症酸中毒）的发生率与患者继续或停止使用CSII的决定无统计学关联。相比之下，在18项日常生活活动中的11项中，继续使用和停止使用CSII的两组之间存在显著差异（p小于0.05）。总体而言，与停止使用CSII的患者相比，继续使用CSII的患者发现在泵治疗期间他们的许多活动有显著改善。两组在CSII被认为对日常活动的干扰程度方面差异不大。然而，与停止使用CSII的患者相比，继续使用CSII的患者发现在进行某些活动时取下泵的必要性显著降低。（摘要截短于250字）
