1 Department of Diabetes Center, Tokyo Women's Medical University School of Medicine , Tokyo, Japan .
2 Steno Diabetes Center Copenhagen , Gentofte, Denmark .
Diabetes Technol Ther. 2018 Mar;20(3):229-234. doi: 10.1089/dia.2017.0231. Epub 2018 Feb 13.
The aim of this study was to evaluate the incidence rates of diabetic ketoacidosis (DKA) according to treatment modality in patients with type 1 diabetes (T1D) in Denmark, either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).
A total of 20,902 T1D registered in the Danish Adult Diabetes Database were followed for an average of 5.4 years. Poisson regression analyses with risk time as offset were used to compare differences in rates of DKA between CSII and MDI. Model was adjusted for age, sex, diabetes duration, previous DKA events, and hemoglobin A (HbA). A modifying effect of number of CSII patients on the DKA rates was tested.
During 113,731 person-years, 3100 DKA events were registered (53 among CSII). CSII patients were younger (42.3 vs. 47.9 years), a larger proportion was female (59% vs. 43%), had a shorter diabetes duration (19 vs. 21 years), and a lower HbA (61.9 vs. 66.6 mmol/mol). There was no significant difference in the incidence rate of DKA between CSII and MDI (rate ratio: 1.30, 95% confidence interval: 0.97-1.76). However, in clinics with at least 250 CSII patients, rates of DKA events were lower among CSII users, while the opposite was true for the smaller clinics (P = 0.016).
Delivery of CSII in large diabetes clinics with sufficient support and patient education may ensure that CSII treatment does not lead to an increased risk of DKA.
本研究旨在评估丹麦使用胰岛素多次皮下注射（MDI）或连续皮下胰岛素输注（CSII）治疗 1 型糖尿病（T1D）患者中，不同治疗方式下糖尿病酮症酸中毒（DKA）的发生率。
共纳入丹麦成人糖尿病数据库中 20902 例 T1D 患者，平均随访 5.4 年。采用风险时间为偏移量的泊松回归分析比较 CSII 与 MDI 治疗组 DKA 发生率的差异。模型调整了年龄、性别、糖尿病病程、既往 DKA 事件及糖化血红蛋白（HbA）。还测试了 CSII 患者数量对 DKA 发生率的影响。
在 113731 人年中，共登记了 3100 例 DKA 事件（CSII 组 53 例）。CSII 患者更年轻（42.3 岁 vs. 47.9 岁），女性比例更高（59% vs. 43%），糖尿病病程更短（19 年 vs. 21 年），HbA 水平更低（61.9 vs. 66.6mmol/mol）。CSII 与 MDI 治疗组 DKA 发生率无显著差异（发生率比：1.30，95%置信区间：0.97-1.76）。然而，在至少有 250 例 CSII 患者的诊所中，CSII 使用者的 DKA 发生率较低，而在较小的诊所中则相反（P=0.016）。
在有足够支持和患者教育的大型糖尿病诊所中提供 CSII 治疗可能确保 CSII 治疗不会增加 DKA 的风险。
