Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri.
Endocr Pract. 2021 Aug;27(8):769-775. doi: 10.1016/j.eprac.2021.05.001. Epub 2021 May 12.
To evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes.
Utilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models.
There was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA.
In a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.
评估哪些因素决定了 1 型糖尿病年轻患者连续皮下胰岛素输注（CSII）的使用模式和结果。
利用 2008 年至 2018 年期间 Optum 去标识电子健康记录数据集，进行回顾性队列研究，我们确定了 2104 名年龄在 18 至 30 岁的 1 型糖尿病患者。我们评估了种族对 CSII 使用、糖化血红蛋白（%）和因糖尿病酮症酸中毒（DKA）住院的影响。使用逻辑回归和线性混合模型计算了粗估计值和调整后估计值。
黑人、西班牙裔、男性和享受政府保险的个体 CSII 使用率较低，这些人群的糖化血红蛋白水平也较高。黑人、西班牙裔和享受政府保险的患者发生 DKA 的几率更高。即使是商业保险，黑人和西班牙裔患者的糖化血红蛋白水平也较高，黑人患者发生 DKA 的几率更高。
在美国的大型电子健康记录数据库中，CSII 的总体使用率较低，特别是在黑人及西班牙裔少数群体中，尽管 CSII 显示出在不增加 DKA 事件的情况下对糖化血红蛋白控制具有优势。
