Yale University School of Nursing, Orange, Connecticut.
Yale University School of Medicine, New Haven, Connecticut.
Sci Diabetes Self Manag Care. 2022 Dec;48(6):476-482. doi: 10.1177/26350106221125699. Epub 2022 Sep 21.
This purpose of the study was to describe recent diabetic ketoacidosis (DKA) incidence data in youth with type 1 diabetes using insulin pumps and the impact of continuous glucose monitors (CGMs) on DKA rates.
DKA data were obtained through a retrospective chart review of insulin pump users (ages <26 years) between December 2019 and June 2021 in an academic pediatric endocrinology practice where 68% of patients were pump users.
Among 591 pump patients, 28 events occurred (3.16 events per 100 patient-years). Mean age was 13.6±3.4 years; 85.7% ranged from 12 to 19 years. Mean A1C was 10.2±2.3%, diabetes duration was 6.1±4.0 years, and 57.1% used CGM. Admission pH levels ranged between 7.0 and 7.31, with 28.6% of events classified as "moderate" and 46.4% "severe." There was no significant difference in the DKA severity between those who wore a CGM and those who did not (ie, pH, serum bicarbonate, mentation alteration, length of stay, intensive care unit admission, and hospital admission). DKA events were attributed to concurrent illness (10.7%), insulin omission (14.3%), pump site failure (57.1%), or other pump malfunctions (14.3%).
DKA events in pump-treated patients were relatively uncommon; most episodes occurred in adolescents with higher A1C levels, and notably, most events could have been avoided if users followed standard troubleshooting guidelines. Thus, DKA prevention education should be reinforced at each encounter, particularly for teens with higher A1C levels. Moreover, more than 50% of those with DKA episodes wore a CGM, suggesting that pump users using CGM require frequent reinforcement of this education and that the development of such educational materials is critical.
本研究旨在描述使用胰岛素泵的青少年 1 型糖尿病患者近期酮症酸中毒（DKA）的发病数据，以及连续血糖监测（CGM）对 DKA 发生率的影响。
通过对 2019 年 12 月至 2021 年 6 月期间在一家学术儿科内分泌科就诊的使用胰岛素泵（年龄<26 岁）的患者进行回顾性图表审查，获得 DKA 数据，其中 68%的患者为泵使用者。
在 591 名泵治疗患者中，发生了 28 起事件（每 100 名患者年发生 3.16 起事件）。患者平均年龄为 13.6±3.4 岁；85.7%的年龄在 12 至 19 岁之间。平均 A1C 为 10.2±2.3%，糖尿病病程为 6.1±4.0 年，57.1%的患者使用 CGM。入院时 pH 值范围在 7.0 至 7.31 之间，28.6%的事件被归类为“中度”，46.4%的事件被归类为“重度”。在 DKA 严重程度方面，使用 CGM 的患者与未使用 CGM 的患者之间无显著差异（即 pH 值、血清碳酸氢盐、精神状态改变、住院时间、入住重症监护病房和住院）。DKA 事件归因于并发疾病（10.7%）、胰岛素遗漏（14.3%）、泵部位故障（57.1%）或其他泵故障（14.3%）。
使用胰岛素泵的患者中 DKA 事件相对较少；大多数事件发生在 A1C 水平较高的青少年中，值得注意的是，如果患者遵循标准故障排除指南，大多数事件是可以避免的。因此，应在每次就诊时加强 DKA 预防教育，特别是对 A1C 水平较高的青少年。此外，超过 50%的 DKA 发作患者佩戴了 CGM，这表明使用 CGM 的泵使用者需要频繁加强这方面的教育，开发此类教育材料至关重要。
