Castillo Echevarría Marinés, Evans Riley E, Schmitt Jessica A
Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States.
Front Endocrinol (Lausanne). 2025 Jun 5;16:1568133. doi: 10.3389/fendo.2025.1568133. eCollection 2025.
At Children's of Alabama, all patients with insulin dependent diabetes are considered for continuous subcutaneous insulin infusion therapy (CSII, also known as insulin pump). In some cases, eligibility depends on insurance requirements, including six months of MDI therapy, CSII education, and a six-week glucose log with four daily readings.
Evaluate factors influencing CSII initiation after "Prepump class" and assess glycemic changes in CSII starters.
A retrospective review of pre-pump class attendees from January 2022 to July 2023 was completed. Patients who initiated a CSII prior to January 2024 were identified as "CSII-starters," and those who remained in multiple daily injections were identified as "MDI-retainers". Demographic and medical data were compared between these groups. For CSII-starters, type of system and use of automatic insulin delivery (AID) was evaluated. Glycemic outcomes were assessed in those with type 1 diabetes (T1D) with continuous glucose monitor data. A sub-analysis was done for those outside the honeymoon period. Outcomes of AID systems and users of non-AID systems were compared.
Of 283 pediatric patients who attended pre-pump class, 187 (66%) started CSII, with a median initiation time of 108 days (interquartile range 76-154). CSII-starters and MDI-retainers differed by race (p=0.0385) and insurance (p=0.0001), but not by sex, language, or age at diagnosis. Initiators were younger (p=0.0150), had shorter diabetes duration (p=0.0001), lower HbA1c (p=0.0020), and higher CGM use (p<0.0001). Among starters, 70% chose tubeless pumps, and 62% (n=116) used AID systems. Race and insurance were not linked to AID vs non-AID choice, but were associated with CSII initiation. Insurance and race were not associated with selecting an AID over non-AID CSII systems. In glycemic analysis, 183 patients were studied. AID systems showed improved outcomes compared to non-AID systems for the full analysis and sub-analysis of patients outside the honeymoon period.
While race and insurance are not associated with the selection of an AID vs non-AID system, they are associated with CSII-starters versus MDI-retainers. As expected, AID systems outperformed non-AID systems in our cohort. Future work will aim to reduce disparities in CSII and AID access for all interested in diabetes technology.
在阿拉巴马州儿童医院，所有胰岛素依赖型糖尿病患者都被考虑接受持续皮下胰岛素输注治疗（CSII，也称为胰岛素泵）。在某些情况下，是否符合条件取决于保险要求，包括六个月的多次皮下注射胰岛素（MDI）治疗、CSII教育以及一份为期六周的每日四次血糖记录。
评估影响“胰岛素泵前课程”后启动CSII的因素，并评估CSII启动者的血糖变化。
对2022年1月至2023年7月参加胰岛素泵前课程的患者进行回顾性研究。在2024年1月之前开始使用CSII的患者被确定为“CSII启动者”，而那些仍采用多次每日注射胰岛素的患者被确定为“MDI维持者”。比较这两组患者的人口统计学和医学数据。对于CSII启动者，评估系统类型和自动胰岛素输送（AID）的使用情况。通过持续葡萄糖监测数据评估1型糖尿病（T1D）患者的血糖结果。对蜜月期以外的患者进行亚组分析。比较AID系统和非AID系统使用者的结果。
在283名参加胰岛素泵前课程的儿科患者中，187名（66%）开始使用CSII，中位启动时间为108天（四分位间距76 - 154天）。CSII启动者和MDI维持者在种族（p = 0.0385）和保险类型（p = 0.0001）方面存在差异，但在性别、语言或诊断时的年龄方面无差异。启动者年龄更小（p = 0.0150）、糖尿病病程更短（p = 0.0001）、糖化血红蛋白（HbA1c）更低（p = 0.0020）且更多使用持续葡萄糖监测（CGM，p < 0.0001）。在启动者中，70%选择了无管胰岛素泵，62%（n = 116）使用AID系统。种族和保险类型与AID或非AID的选择无关，但与CSII启动相关。保险类型和种族与选择AID而非非AID的CSII系统无关。在血糖分析中，对183名患者进行了研究。在对蜜月期以外患者的全面分析和亚组分析中，AID系统显示出比非AID系统更好的结果。
虽然种族和保险类型与AID系统和非AID系统的选择无关，但它们与CSII启动者和MDI维持者有关。正如预期的那样，在我们的队列中，AID系统的表现优于非AID系统。未来的工作旨在减少所有对糖尿病技术感兴趣的人在获得CSII和AID方面的差异。
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