Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre.
Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester.
Diabet Med. 2017 Oct;34(10):1372-1379. doi: 10.1111/dme.13412. Epub 2017 Jul 23.
To compare long-term HbA changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations.
Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA changes associated with different pump makes.
The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA levels improved and improvements were maintained during a follow-up extending to 10 years (HbA : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA lowering in pre-specified subgroups stratified by pre-pump HbA , age or diabetes duration. HbA lowering was positively related to baseline HbA (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024).
Under routine care conditions, there were no covariate-adjusted differences in HbA lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA lowering.
在一项代表其他临床人群的大型 1 型糖尿病成年患者队列中，比较常规护理下不同胰岛素泵相关的长期 HbA1c 变化。
对 1999 年至 2014 年间开始接受泵治疗的 508 名个体（平均年龄 40 岁；55%为女性；糖尿病病程 20 年；94%为 1 型糖尿病；中位随访 3.7 年）进行观察性、回顾性研究。采用混合线性模型比较不同泵种相关的调整协变量后 HbA1c 变化。
比较的泵包括：50%美敦力、24% omnipod、14%罗氏和 12%安易达。HbA1c 水平整体改善，且在长达 10 年的随访期间（HbA1c：持续皮下胰岛素输注（CSII）前 vs. CSII 后 12 个月，71（61，82） vs. 66（56，74）mmol/mol；8.7（7.7，9.6） vs. 8.2（7.3，8.9）%；P＜0.0001）得到维持。HbA1c≥64mmol/mol（8.0%）的个体比例从 CSII 前的 68%降至 55%。调整基线混杂因素后，不同泵种之间的 HbA1c 降低没有差异（P=0.44），包括比较贴片泵与传统导管泵（P=0.63）。在按 CSII 前 HbA1c 、年龄或糖尿病病程分层的预先指定亚组中，不同泵种之间 HbA1c 降低没有显著差异（P＜0.05）。HbA1c 降低与基线 HbA1c 呈正相关（P＜0.001），与糖尿病病程呈负相关（P=0.017），与 CSII 使用年限呈负相关（P=0.024）。
在常规护理条件下，比较不同泵种时，在调整协变量后，HbA1c 降低方面没有差异，包括比较贴片泵与传统导管泵。因此，CSII 泵的选择不应受所需 HbA1c 降低程度的影响。
