Mooney Shane P, Booth Gillian L, Shulman Rayzel, Na Yingbo, Weisman Alanna, Shah Baiju R, Perkins Bruce A, Lipscombe Lorraine
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
Diabet Med. 2021 Nov;38(11):e14618. doi: 10.1111/dme.14618. Epub 2021 Jun 16.
To compare glycaemic control and adverse outcomes between transition-aged and early adults with type 1 diabetes, and the impact of continuous subcutaneous insulin infusion (CSII) therapy funded through a government Assisted Devices Program.
This retrospective cohort study using healthcare administrative databases from Ontario, Canada included adults aged 18-35 with type 1 diabetes between 1 April 2011 and 31 March 2014. Mean HbA was compared between transition-aged (18-24 years) and early adults (25-35 years), overall and stratified by whether or not they received government-funded CSII therapy (CSII vs. non-CSII). Secondary outcomes included rates of hospitalizations/emergency department visits for hyperglycaemia and hypoglycaemia over a 3-year follow-up. Comparisons were adjusted for relevant covariates.
Among 7157 participants with type 1 diabetes, mean HbA was significantly higher for transition-aged compared to early adults (71 mmol/mol [8.68%] vs. 64 mmol/mol [8.04%], p < 0.0001). This difference was smaller among CSII compared to non-CSII users (p = 0.02 for interaction between age group and CSII use). The transition-age group were more likely to experience a hyperglycaemic event compared to early adults (adjusted risk ratio, aRR: 1.56, 95% confidence interval [CI]: 1.25-1.96), which was attenuated by CSII use (aRR: 1.13, 95% CI: 0.7-1.69).
Transition-aged adults with type 1 diabetes had a significantly higher mean HbA and risk of hyperglycaemic events compared to early adults. This difference was attenuated for CSII users, indicating that a government-funded CSII programme is associated with narrowing of the gap in glycaemic control and associated adverse outcomes for this population.
比较1型糖尿病过渡年龄组和青年成年人的血糖控制及不良结局，以及通过政府辅助设备计划资助的持续皮下胰岛素输注（CSII）治疗的影响。
这项回顾性队列研究使用了加拿大安大略省的医疗管理数据库，纳入了2011年4月1日至2014年3月31日期间年龄在18 - 35岁的1型糖尿病成年人。比较了过渡年龄组（18 - 24岁）和青年成年人（25 - 35岁）的平均糖化血红蛋白（HbA），总体比较以及按是否接受政府资助的CSII治疗进行分层比较（CSII组与非CSII组）。次要结局包括3年随访期间高血糖和低血糖的住院/急诊就诊率。对相关协变量进行了调整比较。
在7157名1型糖尿病参与者中，过渡年龄组的平均HbA显著高于青年成年人（71 mmol/mol [8.68%] 对 64 mmol/mol [8.04%]，p < 0.0001）。与非CSII使用者相比，CSII使用者之间的这种差异较小（年龄组与CSII使用之间的交互作用p = 0.02）。与青年成年人相比，过渡年龄组更有可能发生高血糖事件（调整风险比，aRR：1.56，95%置信区间[CI]：1.25 - 1.96），而CSII的使用使其减弱（aRR：1.13，95% CI：0.7 - 1.69）。
与青年成年人相比，1型糖尿病过渡年龄组成年人的平均HbA和高血糖事件风险显著更高。对于CSII使用者，这种差异有所减弱，表明政府资助的CSII计划与该人群血糖控制差距缩小及相关不良结局有关联。
