Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study
Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study
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DOI：
10.1007/s00125-013-3007-9
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发表时间：
2013-11-01
期刊：
影响因子：
8.2
通讯作者：
Davis, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Johnson, Stephanie R.;Cooper, Matthew N.;Davis, Elizabeth A.
我们确定了胰岛素泵治疗对儿童长期血糖控制、BMI、严重低血糖发生率和糖尿病酮症酸中毒 (DKA) 的影响。根据年龄、糖尿病病程和泵启动时的 HbA(1c)，将在一家儿科三级医院接受胰岛素泵治疗的患者与接受注射治疗的患者进行匹配。前瞻性收集 HbA(1c)、人体测量数据、严重低血糖发作次数和 DKA 住院率。共有 345 名接受泵治疗的患者与接受注射的对照组进行匹配。平均年龄、泵开始时糖尿病持续时间和随访时间分别为 11.4 (+/- 3.5)、4.1 (+/- 3.0) 和 3.5 (+/- 2.5) 年。泵组中 HbA(1c) 平均降低率为 0.6% (6.6 mmol/mol)。在 7 年的随访期间，HbA(1c) 的改善仍然显着。泵治疗将严重低血糖事件从每 100 患者年 14.7 次减少到 7.2 次（p < 0.001）。相比之下，同期非泵队列中严重低血糖事件从每 100 患者年 6.8 次增加到 10.2 次。在 1,160 患者年的随访中，泵队列中因 DKA 住院的比率较低（每 100 患者年分别为 2.3 例和 4.7 例，p = 0.003）。这是关于儿童胰岛素泵使用时间最长、规模最大的研究，表明与使用注射的匹配队列相比，泵疗法可持续改善血糖控制，并减少严重低血糖和 DKA 住院率。
We determined the impact of insulin pump therapy on long-term glycaemic control, BMI, rate of severe hypoglycaemia and diabetic ketoacidosis (DKA) in children.Patients on pump therapy at a single paediatric tertiary hospital were matched to patients treated by injections on the basis of age, duration of diabetes and HbA(1c) at the time of pump start. HbA(1c), anthropometric data, episodes of severe hypoglycaemia and rates of hospitalisation for DKA were collected prospectively.A total of 345 patients on pump therapy were matched to controls on injections. The mean age, duration of diabetes at pump start and length of follow-up were 11.4 (+/- 3.5), 4.1 (+/- 3.0) and 3.5 (+/- 2.5) years, respectively. The mean HbA(1c) reduction in the pump cohort was 0.6% (6.6 mmol/mol). This improved HbA(1c) remained significant throughout the 7 years of follow-up. Pump therapy reduced severe hypoglycaemia from 14.7 to 7.2 events per 100 patient-years (p < 0.001). In contrast, severe hypoglycaemia increased in the non-pump cohort over the same period from 6.8 to 10.2 events per 100 patient-years. The rate of hospitalisation for DKA was lower in the pump cohort (2.3 vs 4.7 per 100 patient-years, p = 0.003) over the 1,160 patient-years of follow-up.This is the longest and largest study of insulin pump use in children and demonstrates that pump therapy provides a sustained improvement in glycaemic control, and reductions of severe hypoglycaemia and hospitalisation for DKA compared with a matched cohort using injections.