1 Department of Internal Medicine, Joint Municipal Authority for North Karelia Social and Health Services (Siun sote) , Joensuu, Finland .
2 Health Centre of Outokumpu, Joint Municipal Authority for North Karelia Social and Health Services (Siun sote) , Joensuu, Finland .
Diabetes Technol Ther. 2018 May;20(5):363-369. doi: 10.1089/dia.2018.0027. Epub 2018 May 9.
This study aims to compare glycemic control of persons with type 1 diabetes using multiple daily injections (MDI) with insulin glargine versus insulin detemir or with continuous subcutaneous insulin infusion (CSII) in daily practice.
All adult individuals with type 1 diabetes (n = 1053) were identified from the electronic patient database in North Karelia, Finland. The persons' individual data for insulin treatment, diabetic ketoacidosis (DKA), and hemoglobin A (HbA1c) measurements during the year 2014 were obtained from medical records. Persons using long-acting insulin analogs or CSII were included in the analyses (n = 1004).
Altogether, 47.7% used glargine, 43.9% used detemir, and 8.4% used CSII. The mean HbA1c was lower in the CSII group (63 mmol/mol [7.9%]) compared with the glargine group (66 mmol/mol [8.2%]) or the detemir group (67 mmol/mol [8.3%]). The overall rate of DKA was 5.1% per year. The rate of DKA was higher in the detemir group compared with the glargine group (6.3% per year vs. 3.8% per year, respectively, P < 0.049). In logistic regression analyses, the higher rate of DKA with detemir use was explained by HbA1c.
In daily practice, the glycemic control of type 1 diabetes patients with MDI was similar regardless of basal insulin, glargine, or detemir, whereas CSII allowed better glycemic control than MDI. The rate of DKA was higher with detemir than with glargine, but this is likely related to higher HbA1c rather than insulin regimen.
本研究旨在比较使用多次皮下注射胰岛素（MDI）的 1 型糖尿病患者的血糖控制情况，比较对象为甘精胰岛素、地特胰岛素或持续皮下胰岛素输注（CSII）。
从芬兰北卡累利阿电子患者数据库中筛选出所有成年 1 型糖尿病患者（n=1053）。从病历中获取患者 2014 年胰岛素治疗、糖尿病酮症酸中毒（DKA）和血红蛋白 A（HbA1c）的个人数据。纳入分析的患者使用长效胰岛素类似物或 CSII（n=1004）。
共有 47.7%的患者使用甘精胰岛素，43.9%的患者使用地特胰岛素，8.4%的患者使用 CSII。CSII 组的平均 HbA1c 水平（63mmol/mol[7.9%]）低于甘精胰岛素组（66mmol/mol[8.2%]）或地特胰岛素组（67mmol/mol[8.3%]）。总体 DKA 发生率为每年 5.1%。地特胰岛素组的 DKA 发生率高于甘精胰岛素组（每年 6.3%对每年 3.8%，P<0.049）。在逻辑回归分析中，地特胰岛素组 DKA 发生率较高与 HbA1c 有关。
在日常实践中，使用 MDI 的 1 型糖尿病患者的血糖控制情况相似，与基础胰岛素、甘精胰岛素或地特胰岛素无关，而 CSII 比 MDI 能更好地控制血糖。地特胰岛素的 DKA 发生率高于甘精胰岛素，但这可能与 HbA1c 较高有关，而非胰岛素方案。
