Szypowska Agnieszka, Schwandt Anke, Svensson Jannet, Shalitin Shlomit, Cardona-Hernandez Roque, Forsander Gun, Sundberg Frida, De Beaufort Carine, Maahs David, Maffeis Claudio, O'Riordan Stephen M P, Krisane Iveta Dzivite, Scharf Mauro, Castro Sofia, Konstantinova Maia, Obermannova Barbora, Casteels Kristina, Gökşen Damla, Galhardo Júlia, Kanaka-Gantenbein Christina, Rami-Merhar Birgit, Madacsy Laszlo
Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland.
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
Pediatr Diabetes. 2016 Oct;17 Suppl 23:38-45. doi: 10.1111/pedi.12416. Epub 2016 Jul 15.
Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control.
To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI.
This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out.
Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001).
Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
对于1型糖尿病（T1D）患儿，建议采用每日多次注射（MDI）或持续皮下胰岛素输注（CSII）强化胰岛素治疗，以实现良好的代谢控制。
研究在SWEET（儿科和青少年糖尿病更好控制：努力创建参考中心）中心接受治疗的T1D患儿使用胰岛素泵的频率，并比较接受CSII与MDI治疗的患者之间的代谢控制情况。
本研究纳入了16570名参与SWEET前瞻性、多中心、标准化糖尿病患者登记的T1D患儿。对每位患者最近一年的治疗数据集进行汇总。数据收集至2016年3月。为评估胰岛素泵治疗的组织情况，开展了一项调查。
总体而言，44.4%的T1D患儿接受CSII治疗。胰岛素泵使用患者的比例在各中心之间存在差异，与接受MDI治疗的患儿相比，随年龄增长而降低。在对年龄、性别和糖尿病病程进行校正的逻辑回归分析中，胰岛素泵的使用与以下两者均相关：中心规模[比值比1.51（1.47 - 1.55），P <.0001]和人均糖尿病相关支出[比值比1.55（1.49 - 1.61），P <.0001]。对年龄、性别和糖尿病病程进行校正的线性回归分析表明，与MDI治疗相比，接受CSII治疗的患儿糖化血红蛋白（HbA1c）和每日胰岛素剂量（U/kg/d）均持续降低（P <.0001）。
大多数Sweet中心提供胰岛素泵治疗。各中心之间的差异影响了现代技术的使用频率。尽管各中心存在异质性，但T1D患儿仍能实现相对良好的代谢控制，尤其是接受胰岛素泵治疗的患儿和年龄较小的患儿。
