Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China.
State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
Front Endocrinol (Lausanne). 2021 Mar 2;12:608232. doi: 10.3389/fendo.2021.608232. eCollection 2021.
The incidence of pediatric type 1 diabetes (T1D) is increasing worldwide, and the appropriate choice of therapy regimens is important for children, especially in developing countries with inadequate resources.
We conducted a design combining meta-analysis and prospective cohort study. In meta-analysis, 14 studies involving 69,085 TID cases reported glycosylated hemoglobin (HbA) levels, including 48,363 multiple daily insulin injections therapy (MIT) and 20,722 continuous subcutaneous insulin infusion (CSII). In our prospective cohort study, TID cases were recruited from a tertiary children's hospital, and randomly divided into Group MIT and Group CSII. After the 4-year follow-up, the effects of MDI (n = 112) and CSII (n = 76) therapy on glycemic control, long-term complications, as well as the growth and pubertal development were explored.
Compared to CSII in TID, HbA levels in MDI (WMD = 0.21, 95% CI: 0.20 to 0.23) were increased significantly in meta-analysis. Among 188 clinical cases, mean age at recruitment was 7.55 (SD 2.91) years. Duration of TID was 4.23 (SD 2.61) years. 50.53% (n = 95) of them were boys. The 4-year follow-up showed that children's HbA was 0.67 (95% CI -1.28, -0.05) % lower in children with CSII compared to children with MDI in multivariable regression models with adjustment for potential confounders (children's age at follow-up, duration of TID, gender, birthweight, parity, and delivery method). CSII was associated with 2.31 kg higher in children's weight (95% CI 0.59, 4.04) in the adjusted model. No difference was found in peripheral nerve and fundus consequences as well as the status of obesity and thin and pubertal development between CSII and MIT.
CSII might be associated with better glycemic control and better effect for children growth development. No higher risks of long-term complications and delayed pubertal development were observed in CSII. Our findings provided evidence for a better therapy regimen for T1D in children, nevertheless, they need to be validated by a larger sample size study.
小儿 1 型糖尿病（T1D）的发病率在全球范围内呈上升趋势，对于儿童，尤其是资源不足的发展中国家的儿童，选择合适的治疗方案非常重要。
我们进行了一项结合荟萃分析和前瞻性队列研究的设计。在荟萃分析中，14 项研究共纳入 69085 例 TID 病例，报告了糖化血红蛋白（HbA）水平，其中包括 48363 例多次每日胰岛素注射治疗（MIT）和 20722 例持续皮下胰岛素输注（CSII）。在我们的前瞻性队列研究中，TID 病例从一家三级儿童医院招募，并随机分为 MIT 组和 CSII 组。经过 4 年的随访，探讨了 MDI（n=112）和 CSII（n=76）治疗对血糖控制、长期并发症以及生长和青春期发育的影响。
与 CSII 相比，荟萃分析中 MIT 组的 HbA 水平明显升高（WMD=0.21，95%CI：0.20-0.23）。在 188 例临床病例中，招募时的平均年龄为 7.55（SD 2.91）岁。TID 的病程为 4.23（SD 2.61）年。其中 50.53%（n=95）为男性。多变量回归模型校正潜在混杂因素（随访时儿童年龄、TID 病程、性别、出生体重、产次和分娩方式）后，4 年随访显示，CSII 组儿童的 HbA 较 MDI 组低 0.67%（95%CI：-1.28，-0.05）。校正模型中，CSII 组儿童体重增加 2.31kg（95%CI：0.59，4.04）。CSII 与 MIT 相比，周围神经和眼底并发症、肥胖和消瘦以及青春期发育状况无差异。
CSII 可能与更好的血糖控制和儿童生长发育效果有关。CSII 未观察到长期并发症风险增加和青春期发育延迟。我们的研究结果为儿童 1 型糖尿病提供了更好的治疗方案证据，但需要更大样本量的研究来验证。
