Farhat Ilham, Drishti Shah, Bochner Risa, Bargman Renee
Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Pediatrics, NYC Health + Hospitals/Harlem Hospital, New York, NY, USA.
J Pediatr Endocrinol Metab. 2024 Nov 5;37(12):1028-1035. doi: 10.1515/jpem-2024-0312. Print 2024 Dec 17.
Hybrid closed-loop (HCL) systems improve glycemic control in type 1 diabetes mellitus (T1D), but their effectiveness in young, poorly controlled populations is not established and requires study.
A pre-post study was performed using electronic health records of patients 3-24 years with baseline HbA≥9 % prescribed HCL within the New York City Health+Hospitals System assessing HbA levels and hospitalizations before and after HCL initiation and factors associated with achieving HbA<9 % after HCL initiation.
Of 47 children and adolescents who met inclusion criteria, 4.68 % female, 95.72 % non-White, and 82.22 % covered by public insurance, with a baseline average HbA 10.6 % (2.28 IQR). The most prevalent pump type was Omnipod 5 (70.21 %). The HbA was significantly lower in the postperiod than baseline (HbA before=median 10.6 (IQR2.28), HbA after=median 9.33 (IQR 2.97), difference 1.00 (IQR 1.64), p<0.05) with a decrease in median diabetes-related hospitalizations (preperiod 1.00 (IQR 1.00), postperiod 0.00 (IQR 1.00), difference -1.00, IQR 2, p<0.05). Lower baseline HbA levels made reaching HbA<9 % more likely. Multivariable analysis showed that the odds of having HbA of <9 % was 2.1 times less likely for every one point increase in baseline HbA and 12.5 times less likely for those with a pump at (p<0.05).
HCL therapy improved glycemic control and decreased diabetes-related hospitalizations in youth with poorly controlled T1DM. Higher baseline HbA levels predicted less success with HCL therapy so those who stand to benefit most benefit least.
混合闭环（HCL）系统可改善1型糖尿病（T1D）患者的血糖控制，但该系统在年轻的、血糖控制不佳人群中的有效性尚未得到证实，需要开展研究。
采用纽约市卫生与医院系统内3至24岁、基线糖化血红蛋白（HbA）≥9%且已处方HCL的患者的电子健康记录进行一项前后对照研究，评估启动HCL前后的HbA水平和住院情况，以及启动HCL后HbA<9%的相关因素。
在47名符合纳入标准的儿童和青少年中，女性占4.68%，非白人占95.72%，82.22%有公共保险覆盖，基线平均HbA为10.6%（四分位距2.28）。最常用的泵类型是Omnipod 5（70.21%）。随访期的HbA显著低于基线水平（基线前HbA=中位数10.6（四分位距2.28），随访后HbA=中位数9.33（四分位距2.97），差值1.00（四分位距1.64），p<0.05），糖尿病相关住院中位数减少（基线期1.00（四分位距1.00），随访期0.00（四分位距1.00），差值-1.00，四分位距2，p<0.05）。较低的基线HbA水平使HbA<9%的可能性更高。多变量分析显示，基线HbA每增加1个点，HbA<9%的几率降低2.1倍，使用泵的患者降低12.5倍（p<0.05）。
HCL疗法改善了血糖控制不佳的青少年T1DM患者的血糖控制，并减少了糖尿病相关住院。较高的基线HbA水平预示着HCL疗法的成功率较低，因此受益最大的人群获益最少。
