使用美敦力780G系统对1型糖尿病且糖化血红蛋白（HbA1c）水平极高的儿童和青年患者血糖改善的预测因素
Predictors of glycaemic improvement in children and young adults with type 1 diabetes and very elevated HbA1c using the MiniMed 780G system.
作者信息
Zhou Yongwen, Boucsein Alisa, Michaels Venus R, Gray Madeleine K, Jefferies Craig, Wiltshire Esko, Paul Ryan G, Parry-Strong Amber, Pasha Maheen, Petrovski Goran, de Bock Martin I, Wheeler Benjamin J
机构信息
Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China.
出版信息
Diabetes Obes Metab. 2025 Apr;27(4):2138-2146. doi: 10.1111/dom.16210. Epub 2025 Jan 20.
AIMS
This study aimed to identify key factors with the greatest influence on glycaemic outcomes in young individuals with type 1 diabetes (T1D) and very elevated glycaemia after 3 months of automated insulin delivery (AID).
MATERIALS AND METHODS
Data were combined and analysed from two separate and previously published studies with similar inclusion criteria assessing AID (MiniMed 780G) efficacy among young individuals naïve to AID (aged 7-25 years) with glycated haemoglobin A1c (HbA1c) ≥69 mmol/mol (≥8.5%). Univariate and multivariate linear models were performed to explore factors leading to the greatest improvements in HbA1c and time in range 3.9-10.0 mmol/L (70-180 mg/dL; TIR).
RESULTS
A total of 99 young individuals (aged 17.3 ± 4.2 years; baseline HbA1c 92 ± 21 mmol/mol [10.6% ± 1.9%]) were included. After 3 months of AID use, HbA1c improved to 65 ± 16 mmol/mol (8.1% ± 1.5%) (-27 ± 23 mmol/mol; -2.5% ± 2.1% change), and TIR improved from 24.2% ± 13.5% to 58.4% ± 15.4% (p both <0.001). In the multivariate analysis, two key factors for both HbA1c and TIR improvement were identified: high baseline HbA1c (>100 mmol/mol [>11.0%]) and high time in automation mode (>80%), which led to decreased HbA1c by 27.0 mmol/mol (2.4%) and 14.2 mmol/mol (1.3%) and increased TIR by 6.1% and 11.1% (p all <0.05) respectively. Meal announcement frequency >3 times/day and glucose target of 5.5 mmol/L (100 mg/dL) also led to significant increases in TIR. No other factors, including age, prior use of multiple daily injection, ethnicity, gender and optimal active insulin time 2 h, contributed to statistically significant HbA1c or TIR improvement.
CONCLUSIONS
In young individuals naive to AID, those with the highest baseline HbA1c and high percentage time in automation experience the greatest benefits after initiation of AID. Sociodemographic background and carbohydrate counting adherence/knowledge should not prevent or delay access to AID technology (ACTRN12621000556842 and ACTRN12622001454763).
目的
本研究旨在确定对1型糖尿病（T1D）青年患者血糖结果影响最大的关键因素，这些患者在接受3个月的自动胰岛素输注（AID）后血糖水平非常高。
材料与方法
合并并分析了两项单独的、先前发表的研究数据，这两项研究具有相似的纳入标准，评估了AID（美敦力780G）在初次使用AID的青年患者（7 - 25岁）中的疗效，这些患者糖化血红蛋白A1c（HbA1c）≥69 mmol/mol（≥8.5%）。采用单变量和多变量线性模型来探究导致HbA1c和血糖达标时间范围3.9 - 10.0 mmol/L（70 - 180 mg/dL；TIR）改善最大的因素。
结果
共纳入99名青年患者（年龄17.3 ± 4.2岁；基线HbA1c 92 ± 21 mmol/mol [10.6% ± 1.9%]）。使用AID 3个月后，HbA1c改善至65 ± 16 mmol/mol（8.1% ± 1.5%）（-27 ± 23 mmol/mol；变化-2.5% ± 2.1%），TIR从24.2% ± 13.5%提高到58.4% ± 15.4%（两者p均<0.001）。在多变量分析中，确定了HbA1c和TIR改善均有的两个关键因素：高基线HbA1c（>100 mmol/mol [>11.0%]）和高自动化模式时间（>80%），这分别使HbA1c降低27.0 mmol/mol（2.4%）和14.2 mmol/mol（1.3%），TIR提高6.1%和11.1%（所有p<0.05）。每日进餐提示频率>3次/天和血糖目标5.5 mmol/L（100 mg/dL）也使TIR显著增加。没有其他因素，包括年龄、先前多次每日注射的使用情况、种族、性别和最佳活性胰岛素作用时间2小时，对HbA1c或TIR的改善有统计学显著贡献。
结论
在初次使用AID的青年患者中，基线HbA1c最高且自动化时间百分比高的患者在开始使用AID后获益最大。社会人口统计学背景和碳水化合物计数依从性/知识不应阻碍或延迟使用AID技术（澳大利亚新西兰临床试验注册中心编号：ACTRN12621000556842和ACTRN12622001454763）。
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