Amole Morolake, Whyte Loren, Ghayee Hans K, Bril Fernando, Cusi Kenneth, Leey-Casella Julio
University of Florida, Gainesville.
Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida.
Fed Pract. 2021 Nov;38(Suppl 4):S4-S8. doi: 10.12788/fp.0156.
Advancements in diabetes technology now allow insulin pump and continuous glucose monitor (CGM) technology to be a part of usual US Department Veterans Affairs (VA) clinical care. The automated insulin pump (AIP) delivers insulin automatically based on CGM readings. In randomized clinical trials the closed-loop system has shown to improve glycemic control in children and younger adults with type 1 diabetes mellitus (T1DM) while preventing hypoglycemia. However, its safety and efficacy is less well known in older veterans with T1DM. In this VA pilot study, we aimed to assess AIP technology in the real world of an older population of veterans with T1DM followed in the outpatient setting.
Thirty-seven patients with T1DM new to AIP seen at the Malcom Randall VA Medical Center in Gainesville, Florida, were evaluated between March and December of 2018 on an Medtronic Minimed 670G Insulin Pump System. We collected demographic as well as clinical data before and after the initiation of AIP, including standard insulin pump/CGM information (sensor wear, time in target glucose range, time in automated mode, other).
At the time of the initiation of AIP, the mean (SD) age of patients was 59.1 (14.4) years; 35 identified as male and 2 as female. The mean (SD) duration of T1DM was 25.3 (12.0) years. Patients transitioned from either insulin injections or other non-AIP pump to AIP safely-there was no increase in hypoglycemia, and the mean (SD) hemoglobin A decreased from 7.6% (0.8) to 7.3% (0.8) by the second follow-up visit.
In this real-world study, AIP use was both safe and viable as a tool for T1DM management with older veterans. This technology further engaged veterans in monitoring their blood sugars and achieving more optimal glycemic control. Future long-term, larger studies are much needed in this setting.
糖尿病技术的进步使胰岛素泵和持续葡萄糖监测（CGM）技术成为美国退伍军人事务部（VA）常规临床护理的一部分。自动胰岛素泵（AIP）根据CGM读数自动输送胰岛素。在随机临床试验中，闭环系统已显示可改善1型糖尿病（T1DM）儿童和年轻成人的血糖控制，同时预防低血糖。然而，其在老年T1DM退伍军人中的安全性和有效性尚鲜为人知。在这项VA试点研究中，我们旨在评估AIP技术在门诊环境中对老年T1DM退伍军人实际应用的情况。
2018年3月至12月期间，对佛罗里达州盖恩斯维尔市马尔科姆·兰德尔VA医疗中心37例初次使用AIP的T1DM患者进行了美敦力MiniMed 670G胰岛素泵系统评估。我们收集了开始使用AIP前后的人口统计学和临床数据，包括标准胰岛素泵/CGM信息（传感器佩戴情况、目标血糖范围内的时间、自动模式下的时间等）。
开始使用AIP时，患者的平均（标准差）年龄为59.1（14.4）岁；35例为男性，2例为女性。T1DM平均（标准差）病程为25.3（12.0）年。患者从胰岛素注射或其他非AIP泵安全过渡到AIP——低血糖没有增加，第二次随访时平均（标准差）糖化血红蛋白从7.6%（0.8）降至7.3%（0.8）。
在这项实际应用研究中，AIP作为管理老年退伍军人T1DM的工具既安全又可行。这项技术进一步促使退伍军人参与血糖监测并实现更优化的血糖控制。在此背景下，未来非常需要进行长期、更大规模的研究。
