Porcel-Chacón Rocio, Tapia-Ceballos Leopoldo, Ariza-Jimenez Ana-Belen, Gómez-Perea Ana, Jiménez-Hinojosa José Manuel, López-Siguero Juan-Pedro, Leiva-Gea Isabel
Universitary Costa del Sol Hospital A-7, Km 187, 29603 Málaga, Spain.
Regional University Hospital of Malaga, Avda Arroyo de los Angeles, s/n, 29009 Málaga, Spain.
Diseases. 2025 Aug 9;13(8):254. doi: 10.3390/diseases13080254.
In healthcare centers with limited resources, or for patients who prefer to make continuous changes in their treatment themselves and do not want to rely solely on technology, intermittent glucose monitoring (isCGM) with an insulin pump is a viable option that warrants further study.
prospective single-center study that collected data at 3 months and after isCGM implantation in pediatric patients with Type 1 diabetes, categorized according to their insulin regimen.
We found statistically significant differences in the time in range (TIR) between 70 and 180 mg/dl at 3 months after using the sensor ( = 0.017), although these differences were not maintained at 1 year ( = 0.064). When stricter TIRs (70-140 mg/dl) were analyzed, statistically significant differences were observed at 3 months ( = 0.01) and at 1 year ( = 0.018) in favor of patients using CSII. While 75% of the patients in the CSII group had good control with HbA1c < 7% after one year of sensor use, only 34.6% in the MDI group achieved these values. However, the CSII group presented a higher coefficient of variation (62.31% at 3 months and 43.08% at 1 year) ( = 0.02), and a higher number of hypoglycemic episodes (7.38% and 7.32%, respectively) ( = 0.016). The CSII group also had a higher number of capillary blood glucose measurements at the beginning of the study (8.32/day) ( = 0.249), but this number became similar between both groups after one year.
We found statistically significant differences in favor of CSII over MDI in terms of metabolic control after one year of isCGM use. However, the TIR values were still below the range considered to be indicative of good control. These findings lead us to question whether CSII should be initially considered in specific cases where HCL is not possible, or if it would be more effective to wait until the patient is ready, or the necessary resources are available to start directly CSII integrated in a closed loop system.
在资源有限的医疗中心，或者对于那些希望自行持续调整治疗方案且不想完全依赖技术的患者来说，胰岛素泵联合间歇性血糖监测（isCGM）是一个值得进一步研究的可行选择。
一项前瞻性单中心研究，在1型糖尿病儿科患者植入isCGM后的3个月及之后收集数据，并根据胰岛素治疗方案进行分类。
我们发现，使用传感器3个月后，血糖在70至180mg/dl范围内的时间（TIR）存在统计学显著差异（P = 0.017），不过这些差异在1年后未持续存在（P = 0.064）。当分析更严格的TIR范围（70 - 140mg/dl）时，在3个月（P = 0.01）和1年（P = 0.018）时观察到有利于使用持续皮下胰岛素输注（CSII）患者的统计学显著差异。在使用传感器一年后，CSII组75%的患者糖化血红蛋白（HbA1c）< 7%，血糖控制良好，而在多次皮下注射胰岛素（MDI）组中只有34.6%的患者达到这些值。然而，CSII组的变异系数更高（3个月时为62.31%，1年时为43.08%）（P = 0.02），且低血糖发作次数更多（分别为7.38%和7.32%）（P = 0.016）。CSII组在研究开始时的指尖血糖测量次数也更多（8.32次/天）（P = 0.249），但一年后两组的这一数值变得相似。
我们发现，在使用isCGM一年后，就代谢控制而言，CSII相对于MDI存在统计学显著优势。然而，TIR值仍低于被认为表明血糖控制良好的范围。这些发现使我们质疑，在无法进行强化血糖控制（HCL）的特定情况下，是否应首先考虑CSII，或者等到患者准备好，或者有必要的资源来直接启动集成在闭环系统中的CSII是否会更有效。
