Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark.
Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Acta Diabetol. 2023 Aug;60(8):1089-1097. doi: 10.1007/s00592-023-02081-4. Epub 2023 May 9.
Many adults with type 1 diabetes do not achieve recommended glycemic goals despite intensive insulin therapy using insulin pumps. The aim of this study was to explore associations between clinical and psychosocial factors and HbA1c in insulin pump users to identify and prioritize areas for potential intervention.
A questionnaire-based survey covering clinical and psychosocial aspects of life with type 1 diabetes was distributed to all adult (≥ 18 years) insulin pump users in the Capital Region of Denmark. Responses were combined with data from medical records and national registries. Associations with HbA1c were modeled using regression-based machine learning.
Of 1,591 invited individuals, 770 (48.4%) responded to the survey. Mean HbA1c among responders was 7.3% (56 mmol/mmol), and 35.6% had an HbA1c < 7.0% (53 mmol/mol). Six factors were significantly associated with HbA1c: diabetes duration (0.006% (0.1 mmol/mol) lower HbA1c per 1-year increase in diabetes duration); education (0.4% (4.3 mmol/mol) lower HbA1c with long higher education vs. primary school); insulin type (0.2% (2.2 mmol/mol) lower HbA1c with ultra-rapid-acting insulin vs. rapid-acting insulin); hypoglycemia awareness status (0.2% (2.2 mmol/mol) lower HbA1c with complete unawareness vs. full awareness); insulin device satisfaction (0.2% (2.7 mmol/mol) lower HbA1c per 1-point increase in Insulin Device Satisfaction Survey score); and diabetes distress (0.3% (3.1 mmol/mol) higher HbA1c per 1-point increase in Type 1 Diabetes Distress Scale score).
This study identified several associations between clinical and psychosocial factors and HbA1c that may be considered when developing interventions targeted people with type 1 diabetes.
尽管使用胰岛素泵进行强化胰岛素治疗，但许多 1 型糖尿病成年人仍未达到推荐的血糖目标。本研究旨在探讨临床和心理社会因素与胰岛素泵使用者 HbA1c 的关系，以确定并优先考虑潜在干预的领域。
向丹麦首都地区所有成年（≥18 岁）胰岛素泵使用者发放了一份基于问卷的调查，涵盖了 1 型糖尿病生活的临床和心理社会方面。将回复与病历和国家登记处的数据相结合。使用基于回归的机器学习对与 HbA1c 的关联进行建模。
在邀请的 1591 人中，有 770 人（48.4%）对调查做出了回应。应答者的平均 HbA1c 为 7.3%（56mmol/mmol），35.6%的 HbA1c<7.0%（53mmol/mol）。有 6 个因素与 HbA1c 显著相关：糖尿病病程（糖尿病病程每增加 1 年，HbA1c 降低 0.006%（0.1mmol/mol））；教育程度（与小学相比，接受高等教育时间较长者 HbA1c 降低 0.4%（4.3mmol/mol））；胰岛素类型（速效胰岛素相比超快速胰岛素 HbA1c 降低 0.2%（2.2mmol/mol））；低血糖意识状态（完全无症状相比完全有症状者 HbA1c 降低 0.2%（2.2mmol/mol））；胰岛素装置满意度（胰岛素装置满意度量表评分每增加 1 分，HbA1c 降低 0.2%（2.7mmol/mol））；1 型糖尿病困扰（1 型糖尿病困扰量表评分每增加 1 分，HbA1c 升高 0.3%（3.1mmol/mol））。
本研究确定了临床和心理社会因素与 HbA1c 之间的一些关联，在制定针对 1 型糖尿病患者的干预措施时可以考虑这些关联。
