1型糖尿病患者使用胰岛素泵与糖尿病酮症酸中毒风险：四十年间的长期趋势
Insulin Pump Use and Diabetic Ketoacidosis Risk in Type 1 Diabetes: Secular Trends over Four Decades.
作者信息
Budhram Dalton R, Bapat Priya, Bakhsh Abdulmohsen, Abuabat Mohammad I, Verhoeff Natasha J, Mumford Doug, Cheema Wajeeha, Orszag Andrej, Jain Akshay, Cherney David Z I, Fralick Michael, Alamri Bader N, Weisman Alanna, Lovblom Leif Erik, Perkins Bruce A
机构信息
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Division of General Internal Medicine, Department of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, Ontario, Canada.
出版信息
Diabetes Technol Ther. 2025 Feb;27(2):139-143. doi: 10.1089/dia.2024.0272. Epub 2024 Oct 10.
Continuous subcutaneous insulin infusion (CSII) in type 1 diabetes has been regarded as a major diabetic ketoacidosis (DKA) risk factor. We aimed to determine secular trends in risk since CSII implementation in the 1980s. We assessed the relationship between time-varying CSII use and DKA events from 1983 to 2017 and by each decade in the 1441 Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study participants using crude and adjusted Cox proportional hazards models. Time-varying CSII exposure was associated with significantly higher DKA risk in the 1980s (adjusted hazard ratio [HR] 5.81; 95% confidence interval [CI] 3.28-10.29; < 0.001), but in the 2010s, this risk was not significantly elevated (adjusted HR 1.24; 95% CI 0.73-2.12; = 0.43). DKA risk associated with CSII in type 1 diabetes has declined substantially since the 1980s such that the remaining risk in the past decade appears to be of low magnitude.
1型糖尿病患者持续皮下胰岛素输注（CSII）一直被视为糖尿病酮症酸中毒（DKA）的主要危险因素。我们旨在确定自20世纪80年代实施CSII以来该风险的长期趋势。我们使用原始和校正的Cox比例风险模型，评估了1983年至2017年期间以及糖尿病控制与并发症试验/糖尿病干预与并发症流行病学研究（Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study）的1441名参与者中每个十年的CSII使用随时间变化情况与DKA事件之间的关系。在20世纪80年代，随时间变化的CSII暴露与显著更高的DKA风险相关（校正风险比[HR] 5.81；95%置信区间[CI] 3.28 - 10.29；P < 0.001），但在2010年代，这种风险没有显著升高（校正HR 1.24；95% CI 0.73 - 2.12；P = 0.43）。自20世纪80年代以来，1型糖尿病中与CSII相关的DKA风险已大幅下降，以至于在过去十年中剩余的风险似乎较低。
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