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补贴持续血糖监测对 1 型糖尿病患儿及其父母心理社会结局的改善。

Improvement in Psychosocial Outcomes in Children with Type 1 Diabetes and Their Parents Following Subsidy for Continuous Glucose Monitoring.

机构信息

Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.

Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.

出版信息

Diabetes Technol Ther. 2019 Oct;21(10):575-580. doi: 10.1089/dia.2019.0149. Epub 2019 Aug 22.

Abstract

In April 2017, the Australian Government announced the full subsidy of continuous glucose monitors (CGM) to children and young people <21 years with type 1 diabetes (T1D). This study aimed to evaluate the effect of CGM on psychosocial outcomes in a T1D pediatric population-based sample. Children with T1D, commencing CGM between June 2017 and January 2018, and their parents were recruited in a prospective cohort study in a tertiary pediatric hospital in Western Australia. Parents and children older than 12 years self-completed questionnaires at onset of CGM and 2 months later, on fear of hypoglycemia (FOH) and diabetes treatment satisfaction (DTS). Parents provided measures of sleep quality. Children completed the Gold hypoglycemia awareness score. Hemoglobin A1c (HbA1c) values were compared at baseline (BL) and follow-up (FU). Sixty parents and 38 children provided measures at BL and FU. Parental total FOH decreased (mean score BL vs. FU; 50.0 vs. 44.3,  = 0.004) with reduction in the Worry subscore (28.2 vs. 24.2,  = 0.004). Furthermore, parental and child DTS increased. Parental sleep quality improved ( < 0.001) and overnight finger prick testing decreased ( < 0.001). Impaired hypoglycemic awareness decreased in children (26.3% vs. 10.5%,  = 0.031). HbA1c reduced from 8.4% (68 mmol/mol) to 8.1% (65 mmol/mol) ( = 0.036). Introduction of subsidized CGM showed early improvement in psychosocial and glycemic outcomes in patients and their families in Western Australia. Ongoing evaluation is essential to assess whether equitable access to CGM will translate to sustained benefits for Australian T1D pediatric patients.

摘要

2017 年 4 月,澳大利亚政府宣布全面补贴 21 岁以下 1 型糖尿病(T1D)儿童和青少年的连续血糖监测仪(CGM)。本研究旨在评估 CGM 在 T1D 儿科人群中对心理社会结局的影响。在西澳大利亚州一家三级儿科医院,于 2017 年 6 月至 2018 年 1 月期间开始使用 CGM 的 T1D 儿童及其父母参加了一项前瞻性队列研究。父母和 12 岁以上的儿童在开始使用 CGM 时和 2 个月后,自我完成了对低血糖恐惧(FOH)和糖尿病治疗满意度(DTS)的问卷调查。父母提供了睡眠质量的测量值。儿童完成了 Gold 低血糖意识评分。比较了基线(BL)和随访(FU)时的血红蛋白 A1c(HbA1c)值。60 名父母和 38 名儿童在 BL 和 FU 时提供了测量值。父母的总 FOH 降低(平均得分 BL 与 FU;50.0 与 44.3,=0.004),担忧子量表得分降低(28.2 与 24.2,=0.004)。此外,父母和儿童的 DTS 增加。父母的睡眠质量提高( < 0.001),夜间指尖采血检测减少( < 0.001)。儿童的低血糖意识受损减少(26.3%与 10.5%,=0.031)。HbA1c 从 8.4%(68mmol/mol)降至 8.1%(65mmol/mol)(=0.036)。引入补贴的 CGM 显示,西澳大利亚州患者及其家庭的心理社会和血糖结局在早期得到改善。持续评估对于评估澳大利亚 T1D 儿科患者是否能公平获得 CGM 并持续获益至关重要。

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