Adolfsson Peter, Björnsson Viktor, Hartvig Niels Væver, Kaas Anne, Møller Jonas Bech, Ogionwo Lange Elsa
Department of Pediatrics, The Hospital of Halland, Kungsbacka, Tölövägen 5, 43480, Kungsbacka, Sweden.
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Diabetes Ther. 2022 Jan;13(1):43-56. doi: 10.1007/s13300-021-01177-w. Epub 2021 Nov 8.
Many challenges are associated with optimizing glycemic control in pediatric patients with type 1 diabetes (T1D); combining data from smart insulin pens and continuous glucose monitoring (CGM) could mitigate some of these obstacles.
This one-arm, prospective, observational study investigated the effects of introducing a smart pen on glycemic control in pediatric patients with T1D who were using CGM. Children and adolescents with T1D who had been prescribed a smart pen for basal and/or bolus insulin injections were enrolled from three clinics in Sweden. Outcomes compared between baseline and follow-up (≥ 12 months) included: mean numbers of daily (over 24 h) and nocturnal hypoglycemic or hyperglycemic events; time above range (TAR; > 180 mg/dL); time below range (TBR; level 1: 54 to < 70 mg/dL; level 2: < 54 mg/dL); time in range (TIR; 70-180 mg/dL); and missed bolus-dose (MBD) meals.
Overall, 39 patients were included. Mean numbers of daily hypoglycemic events (- 31.4%; p = 0.00035) and nocturnal hypoglycemic events (- 24.4%; p = 0.043) were significantly reduced from baseline to follow-up. Mean daily TBR level 2 was reduced from 2.82% at baseline to 2.18% at follow-up (- 0.64 percentage points; p = 0.025). There were no statistically significant changes in number of daily hyperglycemic events, MBD meals, TIR, TAR, or TBR level 1.
Introducing smart insulin pens was associated with a reduced number of hypoglycemic events and decreases in TBR level 2, demonstrating a potential benefit for glycemic control in pediatric patients.
在1型糖尿病（T1D）儿科患者中优化血糖控制存在诸多挑战；整合智能胰岛素笔和持续葡萄糖监测（CGM）的数据可缓解其中一些障碍。
这项单臂、前瞻性观察性研究调查了引入智能笔对使用CGM的T1D儿科患者血糖控制的影响。从瑞典的三家诊所招募了已被处方使用智能笔进行基础和/或大剂量胰岛素注射的T1D儿童和青少年。比较基线和随访（≥12个月）期间的结果包括：每日（24小时内）和夜间低血糖或高血糖事件的平均次数；高于范围时间（TAR；>180mg/dL）；低于范围时间（TBR；1级：54至<70mg/dL；2级：<54mg/dL）；血糖正常时间（TIR；70 - 180mg/dL）；以及遗漏大剂量胰岛素注射（MBD）的餐次。
总共纳入了39例患者。从基线到随访，每日低血糖事件的平均次数（-31.4%；p = 0.00035）和夜间低血糖事件的平均次数（-24.4%；p = 0.043）显著减少。每日TBR 2级从基线时的2.82%降至随访时的2.18%（-0.64个百分点；p = 0.025）。每日高血糖事件次数、MBD餐次、TIR、TAR或TBR 1级无统计学显著变化。
引入智能胰岛素笔与低血糖事件数量减少以及TBR 2级降低相关，表明对T1D儿科患者的血糖控制有潜在益处。
