Research Group in Diabetes and New Technologies, Pontificia Universidad Javeriana, Bogotá, Colombia; Neuroscience and Aging Research Group, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Geriatrics Unit, Bogotá, Colombia.
Research Group in Diabetes and New Technologies, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Endocrinology Unit, Bogotá, Colombia.
Diabetes Metab Syndr. 2021 May-Jun;15(3):649-653. doi: 10.1016/j.dsx.2021.02.029. Epub 2021 Feb 24.
The literature has supported the efficacy and safety of insulin pump therapy in young adults diagnosed with type 1 diabetes (DM1). However, there is limited evidence in older adults with DM1 and DM2.
A retrospective cohort study was conducted in patients ≥60 years-old with DM1 and DM2, who started Sensor Augmented Insulin Pump therapy with low-glucose suspend feature (SAP + LGS) at Hospital Universitario San Ignacio diabetes center in Bogotá, Colombia. Patients were evaluated between 2009 and 2019 and were treated with Paradigm VEO or Medtronic MiniMed 640 insulin pumps and continuous glucose monitoring system. Glycated hemoglobin (A1c), severe hypoglycemia and hypoglycemia unawareness were assessed at least every 3 months, and hospitalizations and ketoacidosis episodes incidence were assessed yearly.
36 patients were analyzed, (67.36 ± 4.88 years-old) (body mass index 25.48 ± 4.61 kg/m2). The most common indications for starting SAP + LGS were hypoglycemia (58.3%), high glycemic variability (25.0%) and poor metabolic control (16.7%). 26 patients used VEO (72.2%) whereas 27.8% started 640 insulin pump. Data from 32 participants showed A1c decreased from 8.57 ± 1.73% to 7.42 ± 0.96 after a year of therapy (Mean difference -1.15%, p < 0.05); 28.12% reached A1c levels <7% and 42.85% < 7.5%. There was a significant decrease in the proportion of patients with at least one severe hypoglycemia (56.7 vs 3.3%), one or more hospitalizations (20 vs 3.3%), and hypoglycemia unawareness after the first year of follow-up (p < 0.05).
These results suggest that SAP + LGS is safe and effective in people 60 years or older after one year of therapy. Future randomized clinical trials are needed in the elderly.
文献支持胰岛素泵治疗在诊断为 1 型糖尿病（DM1）的年轻成人中的疗效和安全性。然而，在 1 型和 2 型糖尿病的老年患者中，证据有限。
对哥伦比亚波哥大圣伊西德罗大学医院接受带低血糖暂停功能的传感器增强型胰岛素泵治疗（SAP+LGS）的≥60 岁 1 型和 2 型糖尿病患者进行了回顾性队列研究。患者于 2009 年至 2019 年进行评估，并接受 Paradigm VEO 或 Medtronic MiniMed 640 胰岛素泵和连续血糖监测系统治疗。每 3 个月至少评估糖化血红蛋白（A1c）、严重低血糖和无症状性低血糖，并每年评估住院和酮症酸中毒发作的发生率。
共分析了 36 例患者（67.36±4.88 岁）（体重指数 25.48±4.61kg/m2）。开始 SAP+LGS 的最常见指征是低血糖（58.3%）、高血糖变异性（25.0%）和代谢控制不佳（16.7%）。26 例患者使用了 VEO（72.2%），而 27.8%的患者开始使用 640 胰岛素泵。32 名参与者的数据显示，治疗 1 年后 A1c 从 8.57±1.73%降至 7.42±0.96%（平均差值-1.15%，p<0.05）；28.12%的患者达到 A1c 水平<7%，42.85%<7.5%。在第一年随访后，至少发生一次严重低血糖（56.7%比 3.3%）、一次或多次住院（20%比 3.3%）和无症状性低血糖的患者比例显著下降（p<0.05）。
这些结果表明，SAP+LGS 在治疗 1 年后对 60 岁或以上的人群是安全有效的。需要对老年人进行未来的随机临床试验。
