2-6 岁 1 型糖尿病儿童在儿科 MiniMed™ 670G 系统试验中的血糖控制结果。

Glycemic outcomes of children 2-6 years of age with type 1 diabetes during the pediatric MiniMed™ 670G system trial.

机构信息

Division of Pediatric Endocrinology, Barbara Davis Center, Aurora, Colorado, USA.

Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA.

出版信息

Pediatr Diabetes. 2022 May;23(3):324-329. doi: 10.1111/pedi.13312. Epub 2022 Jan 31.

Abstract

BACKGROUND

Highly variable insulin sensitivity, susceptibility to hypoglycemia and inability to effectively communicate hypoglycemic symptoms pose significant challenges for young children with type 1 diabetes (T1D). Herein, outcomes during clinical MiniMed™ 670G system use were evaluated in children aged 2-6 years with T1D.

METHODS

Participants (N = 46, aged 4.6 ± 1.4 years) at seven investigational centers used the MiniMed™ 670G system in Manual Mode during a two-week run-in period followed by Auto Mode during a three-month study phase. Safety events, mean A1C, sensor glucose (SG), and percentage of time spent in (TIR, 70-180 mg/dl), below (TBR, <70 mg/dl) and above (TAR, >180 mg/dl) range were assessed for the run-in and study phase and compared using a paired t-test or Wilcoxon signed-rank test.

RESULTS

From run-in to end of study (median 87.1% time in auto mode), mean A1C and SG changed from 8.0 ± 0.9% to 7.5 ± 0.6% (p < 0.001) and from 173 ± 24 to 161 ± 16 mg/dl (p < 0.001), respectively. Overall TIR increased from 55.7 ± 13.4% to 63.8 ± 9.4% (p < 0.001), while TBR and TAR decreased from 3.3 ± 2.5% to 3.2 ± 1.6% (p = 0.996) and 41.0 ± 14.7% to 33.0 ± 9.9% (p < 0.001), respectively. Overnight TBR remained unchanged and TAR was further improved 12:00 am-6:00 am. Throughout the study phase, there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA) and no serious adverse device-related events.

CONCLUSIONS

At-home MiniMed™ 670G Auto Mode use by young children safely improved glycemic outcomes compared to two-week open-loop Manual Mode use. The improvements are similar to those observed in older children, adolescents and adults with T1D using the same system for the same duration of time.

摘要

背景

胰岛素敏感性差异大、易发生低血糖以及无法有效沟通低血糖症状,这些都给 2-6 岁的 1 型糖尿病(T1D)患儿带来了巨大挑战。本研究旨在评估 2-6 岁 T1D 患儿使用 MiniMedTM 670G 系统时的临床疗效。

方法

来自 7 家研究中心的 46 名患儿(年龄 4.6±1.4 岁)在为期两周的磨合期内使用 MiniMedTM 670G 系统手动模式,然后在为期三个月的研究期内使用自动模式。评估磨合期和研究期的安全性事件、平均糖化血红蛋白(A1C)、传感器血糖(SG)以及血糖在目标范围内(TIR,70-180mg/dl)、低于目标范围(TBR,<70mg/dl)和高于目标范围(TAR,>180mg/dl)的时间百分比。使用配对 t 检验或 Wilcoxon 符号秩检验比较磨合期和研究期的结果。

结果

从磨合期到研究结束(自动模式使用率中位数为 87.1%),平均 A1C 和 SG 分别从 8.0±0.9%降至 7.5±0.6%(p<0.001)和从 173±24mg/dl 降至 161±16mg/dl(p<0.001)。总的 TIR 从 55.7±13.4%增加到 63.8±9.4%(p<0.001),而 TBR 和 TAR 分别从 3.3±2.5%降至 3.2±1.6%(p=0.996)和从 41.0±14.7%降至 33.0±9.9%(p<0.001)。夜间 TBR 保持不变,凌晨 12 点至早上 6 点的 TAR 进一步改善。整个研究期间,没有发生严重低血糖或糖尿病酮症酸中毒(DKA),也没有发生严重的与设备相关的不良事件。

结论

与两周的开环手动模式相比,儿童在家中使用 MiniMedTM 670G 自动模式可更安全地改善血糖控制。与使用相同系统且时间相同的年龄较大的儿童、青少年和成年人相比,改善情况相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d3d/9304187/be5ed6c647b6/PEDI-23-324-g001.jpg

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