Insulin-Pump Therapy for Type 1 Diabetes Mellitus
Insulin-Pump Therapy for Type 1 Diabetes Mellitus
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DOI：
10.1056/nejmct1113948
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发表时间：
2012-04-26
影响因子：
158.5
通讯作者：
Pickup, John C.
中科院分区：
文献类型：
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作者：
Pickup, John C.
一位39岁的男性，患有1型糖尿病27年，拜访他的内分泌科医生，检查他的血糖控制情况。他超重（体重指数[体重（公斤）除以身高（米）的平方]，28.4）。总体血糖控制不佳，近年来糖化血红蛋白值为7.5%至8.0%。他报告说，自我监测的血糖浓度出现不可预测的波动，严重低血糖症频繁发作，这明显扰乱了他的工作和家庭生活。他还报告说，他现在的低血糖警告症状比以前少。尽管患者尽最大努力通过强化胰岛素注射治疗、定期到糖尿病诊所就诊以及糖尿病护士教育者的投入来实现血糖控制，但这些发现仍然存在。他在1年前参加了结构化糖尿病教育课程，他发现该课程有用，并导致糖化血红蛋白水平略有改善;但是，低血糖发作的频率没有变化。他的内分泌学家已经排除了并存疾病，包括腹腔疾病和爱迪生氏病，作为血糖控制不佳的原因，并想知道胰岛素泵治疗的试验是否合适。由于内分泌科医生自己对这种治疗没有什么经验，他会把病人转到一个有专门胰岛素泵诊所的中心。
A 39-year-old man with type 1 diabetes of 27 years' duration visits his endocrinologist for review of his blood glucose control. He is overweight (body-mass index [the weight in kilograms divided by the square of the height in meters], 28.4). The overall glycemic control has been suboptimal, with glycated hemoglobin values of 7.5 to 8.0% in recent years. He reports unpredictable swings in self-monitored blood glucose concentrations and frequent episodes of severe hypoglycemia, which markedly disrupt his work and home life. He also reports that he now has fewer warning symptoms of hypoglycemia than he had previously. These findings are present despite the patient's best efforts to achieve glycemic control with intensified insulin-injection therapy, regular visits to a diabetes clinic, and input from diabetes nurse educators. He attended a structured diabetes education course 1 year previously, which he found to be useful and which led to slight improvements in glycated hemoglobin levels; however, the frequency of hypoglycemic episodes was unchanged. His endocrinologist has ruled out coexisting illnesses, including celiac disease and Addison's disease, as causes of poor glycemic control and wonders whether a trial of insulin-pump therapy is appropriate. Since the endocrinologist has little experience with this type of therapy himself, he refers the patient to a center with a specialized insulin-pump clinic.