Department of Diabetes and Endocrinology, Diabetes Centre, Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil CF47 9DT, United Kingdom.
Department of Diabetes and Endocrinology, Diabetes Centre, Prince Charles Hospital, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil CF47 9DT, United Kingdom.
Diabetes Res Clin Pract. 2020 Aug;166:108281. doi: 10.1016/j.diabres.2020.108281. Epub 2020 Jul 3.
To evaluate the effect of continuous subcutaneous insulin infusion (CSII) on glycaemic control, hypoglycaemia and emotional distress in adults with type 1 diabetes (T1D) during the first 12 months.
47 patients were started on CSII as per NICE guidelines. Anthropometric, clinical and biochemical parameters, hypoglycaemia rates and emotional distress measured by Problem Areas in Diabetes questionnaires (PAID) were recorded at baseline and during follow up at 3-6 months and 6-12 months.
Mean HbA1c dropped by 1.1% (11.8 mmol/mol; p < 0.0001) at 3-6 months and by 0.8% (8.6 mmol/mol; p = 0.008) at 6-12 months. Most patients had improved HbA1c between 6.5 and 8.5% (48-69 mmol/mol) during these follow ups (68.3% and 71.5% respectively). Frequency of hypoglycaemia reduced from 338.2 to 187.2 and 155.3 per 100 patient years during follow ups. Severe hypoglycaemia also decreased from 48.9 to 8.5 and 6.3 per 100 patient years respectively. PAID scores improved from 29.8 ± 18.5 to 17.2 ± 14.0 (p = 0.0002) at 3-6 months and to 12.8 ± 11.7 (p < 0.00001) at 6-12 months. Reduction in HbA1c, insulin dose and PAID scores was more significant in group with HbA1c > 8.5% (69 mmol/mol) at baseline whereas improvement in episodes of hypoglycaemia and severe hypoglycaemic was more in patients who had HbA1c ≤ 8.5% before commencement of CSII therapy.
CSII therapy led to early improvement in glycaemic control, rates of hypoglycaemia and diabetes specific emotional distress. As beneficial effects are recorded within the first few months, CSII therapy should be started more proactively in T1D.
评估连续皮下胰岛素输注（CSII）对 1 型糖尿病（T1D）成人患者在最初 12 个月内血糖控制、低血糖和情绪困扰的影响。
根据 NICE 指南，47 名患者开始接受 CSII 治疗。在基线和随访 3-6 个月和 6-12 个月时，记录体重指数、临床和生化参数、低血糖发生率和糖尿病相关问题领域（PAID）问卷评估的情绪困扰。
在 3-6 个月时，HbA1c 平均下降 1.1%（11.8mmol/mol；p<0.0001），在 6-12 个月时下降 0.8%（8.6mmol/mol；p=0.008）。在这些随访期间，大多数患者的 HbA1c 改善至 6.5-8.5%（48-69mmol/mol）之间（分别为 68.3%和 71.5%）。低血糖发作频率从 100 名患者每年 338.2、187.2 和 155.3 次减少至随访期间。严重低血糖发作也从每年 48.9、8.5 和 6.3 次减少。PAID 评分从 3-6 个月时的 29.8±18.5 改善至 17.2±14.0（p=0.0002），6-12 个月时改善至 12.8±11.7（p<0.00001）。在基线时 HbA1c>8.5%（69mmol/mol）的患者中，HbA1c、胰岛素剂量和 PAID 评分的降低更为显著，而在开始 CSII 治疗前 HbA1c≤8.5%的患者中，低血糖和严重低血糖发作的改善更为显著。
CSII 治疗可早期改善血糖控制、低血糖发作率和糖尿病相关情绪困扰。由于在最初几个月内记录到有益效果，因此应更积极地在 T1D 中开始 CSII 治疗。
