Schmidt Signe, Vistisen Dorte, Almdal Thomas, Hommel Eva, Nørgaard Kirsten
Department of Endocrinology, Hvidovre University Hospital, Hvidovre, Denmark; Danish Diabetes Academy, Odense, Denmark.
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Diabetes Res Clin Pract. 2017 Aug;130:61-66. doi: 10.1016/j.diabres.2017.05.021. Epub 2017 May 19.
The purpose of this secondary analysis of the StenoABC Study was to identify determinants of the changes in HbA1c observed after training of people with type 1 diabetes in advanced carbohydrate counting (ACC) and automated bolus calculator (ABC) use, and further to investigate psychosocial effects of these insulin dosing approaches.
Validated diabetes-specific questionnaires were used to assess diabetes treatment satisfaction, problem areas in diabetes, fear of hypoglycemia and diabetes dependent quality of life before and one year after the training. In addition, numeracy was tested (using a non-validated test developed specifically for this study) and behavioral measures (number of daily blood glucose measurements and self-reported use of ACC) were obtained. Associations between change in HbA1c and these measures plus sex, age, diabetes duration and BMI were tested.
Numeracy was the only baseline predictor of yearly change in HbA1c identified. Higher levels of numeracy were associated with greater reductions in HbA1c (P=0.031). No associations between change in HbA1c and the behavioral measures investigated were found, nor were any clinically relevant associations between changes in HbA1c and questionnaire scores. Treatment satisfaction increased in all users of ACC (P<0.001). People who also used an ABC reported significantly lower levels of fear of hypoglycemia than people who practiced ACC without such device (P=0.005).
Improvements in HbA1c after training in ACC were inversely related to numeracy. Use of an ABC did not compensate for poor numeracy skills. However, device use reduced fear of hypoglycemia compared with ACC without ABC use.
本项对斯滕诺ABC研究的二次分析旨在确定1型糖尿病患者接受强化碳水化合物计数（ACC）和自动推注计算器（ABC）使用培训后糖化血红蛋白（HbA1c）变化的决定因素，并进一步研究这些胰岛素给药方法的心理社会影响。
使用经过验证的糖尿病专用问卷在培训前和培训后一年评估糖尿病治疗满意度、糖尿病问题领域、低血糖恐惧以及糖尿病相关生活质量。此外，进行了算术能力测试（使用专门为本研究开发的未经验证的测试），并获取了行为指标（每日血糖测量次数和自我报告的ACC使用情况）。测试了HbA1c变化与这些指标以及性别、年龄、糖尿病病程和体重指数之间的关联。
算术能力是所确定的HbA1c年度变化的唯一基线预测因素。算术能力水平较高与HbA1c降低幅度较大相关（P = 0.031）。未发现HbA1c变化与所研究的行为指标之间存在关联，HbA1c变化与问卷得分之间也未发现任何具有临床意义的关联。所有ACC使用者的治疗满意度均有所提高（P < 0.001）。同时使用ABC的人报告的低血糖恐惧水平明显低于仅使用ACC而未使用该设备的人（P = 0.005）。
ACC培训后HbA1c的改善与算术能力呈负相关。使用ABC并不能弥补算术技能较差的问题。然而，与未使用ABC的ACC相比，使用该设备可降低低血糖恐惧。
