Schoelwer Melissa J, Bisio Alessandro, Breton Marc D, DeBoer Mark D
University of Virginia Center for Diabetes Technology, Charlottesville, Virginia, USA.
Diabetes Technol Ther. 2022 Apr;24(4):285-288. doi: 10.1089/dia.2021.0405.
We assessed predictors of rising hemoglobin A1c (HbA1c) during long-term use of closed-loop control (CLC) in children aged 6-13 years with type 1 diabetes. Participants used a CLC system during a 16-week randomization phase followed by a 12-week extension phase. We compared an "Increased-HbA1c" group ( = 17, ≥0.5% rise in HbA1c between randomization and extension phases) to a "Maintained-Improvement" group ( = 18, had stable or improved HbA1c). The Increased-HbA1c group had higher pre-CLC HbA1c (8.42% ± 0.80 vs. 7.45% ± 0.93, = 0.002). Contrary to a-priori hypotheses, there were no differences in Δ-height-for-age -score, a surrogate for a pubertal growth spurt (+0.16 vs. -0.15, = 0.113), or number of carbohydrate boluses per day, a surrogate for missed boluses (4.4 ± 2.2 vs. 5.2 ± 2.1, = 0.263). Both groups maintained high rates in closed-loop. Thus, some children exhibit meaningful rise in HbA1c after initial CLC use, likely from multiple contributing factors, and may benefit from added encouragement during ongoing use.
我们评估了6至13岁1型糖尿病儿童长期使用闭环控制（CLC）期间血红蛋白A1c（HbA1c）升高的预测因素。参与者在16周的随机分组阶段使用了CLC系统，随后是12周的延长期。我们将“HbA1c升高”组（n = 17，随机分组阶段至延长期HbA1c升高≥0.5%）与“维持改善”组（n = 18，HbA1c稳定或改善）进行了比较。“HbA1c升高”组的CLC前HbA1c较高（8.42%±0.80 vs. 7.45%±0.93，P = 0.002）。与先验假设相反，在年龄别身高变化评分（青春期生长突增的替代指标，+0.16 vs. -0.15，P = 0.113）或每日碳水化合物推注次数（遗漏推注的替代指标，4.4±2.2 vs. 5.2±2.1，P = 0.263）方面没有差异。两组在闭环中的使用率都很高。因此，一些儿童在初次使用CLC后HbA1c出现有意义的升高，可能是多种因素共同作用的结果，在持续使用过程中可能受益于更多的鼓励。
