1 Research Platform on obesity, metabolism and diabetes, Institut de Recherches Cliniques de Montréal (IRCM) , Montréal, Québec, Canada .
2 Department of Biomedical Sciences, Faculty of Medecine, Université de Montréal , Édouard-Montpetit, Montréal, Québec, Canada .
Diabetes Technol Ther. 2018 Jul;20(7):506-515. doi: 10.1089/dia.2018.0110.
Increasing proportions of patients with diabetes use continuous subcutaneous insulin infusion (CSII) therapy mostly due to its clinical efficacy and flexibility for insulin dosing and adjustments. Some challenges are nevertheless associated with this technology. A key and underlooked component of CSII technical difficulties is the subcutaneous catheter used to infuse insulin. Several adverse events (AEs) have been experienced by patients in relation to catheters, such as blockage, kinking, and insertion site reactions, including irritation, infections, lipohypertrophies etc., all of which could compromise the metabolic control. With the objective of minimizing these AEs, recommendations for changing catheters every 2-3 days have historically been provided by manufacturers based on reports derived from small studies and anecdotal data. The aim of this review was to provide an updated analysis of current recommendations and patients' practices in relation to frequency of catheter change. Our main findings are: (1) adequately designed and powered studies investigating optimal catheter wearing time are still lacking; (2) increasing catheter wearing time is generally associated with increased frequency of catheter AEs; (3) however, interpatient variability is large, with some individuals needing to change their catheters every 2-3 days, whereas others probably being able to keep them in place for longer periods without problems. Further research is thus warranted to provide more solid and evidence-based recommendations while exploring personalized approaches at the same time. Increasing catheter wear life without significant side effects is an important goal to simplify CSII therapy and reduce its associated costs and burdens.
越来越多的糖尿病患者使用持续皮下胰岛素输注 (CSII) 疗法，主要是因为其在胰岛素给药和调整方面具有临床疗效和灵活性。然而，这种技术也存在一些挑战。CSII 技术困难的一个关键且被忽视的组成部分是用于输注胰岛素的皮下导管。患者在使用导管时经历了一些不良事件 (AE)，如导管堵塞、扭结和插入部位反应，包括刺激、感染、脂肪肥厚等，所有这些都可能影响代谢控制。为了最大限度地减少这些 AE，制造商根据来自小型研究和轶事数据的报告，建议每 2-3 天更换一次导管。本综述的目的是提供有关导管更换频率的当前建议和患者实践的最新分析。我们的主要发现是：（1）仍缺乏充分设计和有力的研究来调查最佳导管佩戴时间；（2）增加导管佩戴时间通常与导管 AE 的发生频率增加有关；（3）然而，个体间的差异很大，有些患者需要每 2-3 天更换一次导管，而有些患者可能可以长时间保持导管而不会出现问题。因此，有必要进行进一步的研究，以提供更可靠和基于证据的建议，同时探索个性化方法。在不产生明显副作用的情况下增加导管的使用时间是简化 CSII 治疗并降低其相关成本和负担的重要目标。
