Gerber Samantha, Kwong Grace P S, Ho Josephine
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Alberta Children's Hospital Research Institute and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
J Clin Transl Endocrinol. 2024 Jul 20;37:100363. doi: 10.1016/j.jcte.2024.100363. eCollection 2024 Sep.
To assess change in total daily dose (TDD) of insulin following a switch from subcutaneous (SC) injections to continuous subcutaneous insulin infusion (CSII) in pediatric patients with type 1 diabetes (T1D). Secondary objectives were to determine the change in %basal insulin, insulin to carbohydrate (I:C) ratios, insulin sensitivity factor (ISF), and HbA1c/IDAA1c.
A retrospective chart review of patients < 18 years of age who transitioned from SC to CSII at the Alberta Children's Hospital (Calgary, Alberta, Canada) between January 2019 and March 2022.
There was an increase of 0.04 units/kg/day in TDD from baseline vs 1-3 months later (p = 0.04, 95 % confidence interval (CI) [0.002, 0.072]). When stratified by age, a similar increase in TDD was observed in age 5-12 years only (p = 0.05, 95 % CI [0.0006, 0.8236]). There was a decrease in overall %basal insulin by 3 (44 % of TDD at baseline vs 41 % of TDD on CSII). (p = 0.02, 95 % CI [-5.5, -0.4]). No strengthening was seen in I:C ratios from baseline vs 1-3 months later. There was a significant strengthening of I:C ratios at all meals in the basal bolus group from 1-3 weeks to 1-3 months post-CSII; overall strengthening of ISF at both time points; and an overall HbA1c decrease -0.30 (p < 0.0001, CI [-0.45, -0.15]). Each extra year with diabetes was associated with a decrease in HbA1c by 0.07 % (p = 0.006).
TDD of insulin was not found to be decreased post CSII initiation and patient characteristics should be considered when changing from SC to CSII. HbA1c was significantly improved post CSII.
评估1型糖尿病（T1D）儿科患者从皮下（SC）注射胰岛素转换为持续皮下胰岛素输注（CSII）后每日胰岛素总剂量（TDD）的变化。次要目标是确定基础胰岛素百分比、胰岛素与碳水化合物比值（I:C）、胰岛素敏感性因子（ISF）以及糖化血红蛋白/国际糖尿病联盟糖化血红蛋白（HbA1c/IDAA1c）的变化。
对2019年1月至2022年3月期间在加拿大艾伯塔省卡尔加里市艾伯塔儿童医院从SC转换为CSII的18岁以下患者进行回顾性病历审查。
与基线相比，1至3个月后TDD增加了0.04单位/千克/天（p = 0.04，95%置信区间[CI][0.002，0.072]）。按年龄分层时，仅在5至12岁年龄组中观察到TDD有类似增加（p = 0.05，95% CI[0.0006，0.8236]）。基础胰岛素总体百分比下降了3个百分点（基线时占TDD的44%，CSII时占TDD的41%）（p = 0.02，95% CI[-5.5，-0.4]）。与基线相比，1至3个月后I:C比值未见增强。在CSII后1至3周与1至3个月期间，基础大剂量组所有餐次的I:C比值均有显著增强；两个时间点的ISF总体均增强；糖化血红蛋白总体下降了0.30（p < 0.0001，CI[-0.45，-0.15]）。糖尿病病程每增加1年，糖化血红蛋白下降0.07%（p = 0.006）。
开始CSII治疗后未发现胰岛素TDD降低，从SC转换为CSII时应考虑患者特征。CSII治疗后糖化血红蛋白有显著改善。
