Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: A follow-up report
Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: A follow-up report
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DOI：
10.1542/peds.2004-0092
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发表时间：
2004-12-01
期刊：
影响因子：
8
通讯作者：
Tamborlane, WV
中科院分区：
文献类型：
--
作者：
Weinzimer, SA;Ahern, JH;Tamborlane, WV
Objective.近年来，持续皮下胰岛素输注（CSII）的使用急剧增加，胰岛素泵治疗已被证明是成人和老年1型糖尿病儿科患者每日多次注射的安全有效的替代方案。然而，它在非常年幼的儿童中的使用是有限的，尽管这一群体可能会从CSII中受益最多。本研究的目的是分析CSII在我们的糖尿病临床数据库中的1型糖尿病患儿中的疗效和安全性数据。比较7岁以前开始CSII治疗的所有儿童在CSII治疗前一年的糖化血红蛋白（HbA（1c））、严重低血糖（SH）和酮症酸中毒（DKA）与泵治疗期间的相应值。对65名儿童（开始CSII时平均年龄：4.5岁;范围：1.4-6.9岁; 28名女孩; 3名黑人，1名西班牙裔）进行了>162患者-年的随访分析。CSII治疗12个月后，平均HbA（1c）（泵前7.4 +/- 1.0）降至7.0 +/- 0.9，甚至在CSII治疗4年后仍持续改善。SH发生率降低了53%（从78/100患者-年降至37/100患者-年）。从付费护理人员那里接受日间护理的儿童（n = 26）的HbA（1c）和低血糖频率显著降低。在CSII前一年没有需要紧急治疗的DKA发作，在转换为泵后有4次发作（4/100患者-年）。CSII是优化非常年轻的1型糖尿病患者血糖控制的一种持久有效的方法，在最大限度地降低该年龄组严重低血糖风险方面可能上级每日多次注射。雇用有偿护理人员并不妨碍安全有效地使用CSII。
Objective. Use of continuous subcutaneous insulin infusion (CSII) has increased dramatically in recent years, and pump therapy has been shown to be a safe and effective alternative to multiple daily injections in adults and older pediatric patients with type 1 diabetes. Its use in very young children, however, has been limited, although this group might be expected to benefit the most from CSII. The objective of this study was to analyze the CSII efficacy and safety data in very young children with type 1 diabetes from our Diabetes Clinic database.Methods. Glycosylated hemoglobin (HbA(1c)), severe hypoglycemia (SH), and ketoacidosis (DKA) in the year before CSII were compared with corresponding values during pump treatment in all children who started CSII before age 7.Results. Sixty-five children (mean age: 4.5 y at CSII initiation; range: 1.4-6.9 years; 28 girls; 3 black, 1 Hispanic) were analyzed for >162 patient-years of follow-up. Mean HbA(1c) (7.4 +/- 1.0 prepump) decreased to 7.0 +/- 0.9 after 12 months of CSII and continued to improve even after 4 years on CSII. The rate of SH was reduced by 53% (from 78 to 37/100 patient-years). Children who received daytime care from paid caregivers (n = 26) experienced significant reductions in HbA(1c) and hypoglycemia frequency. There were no episodes of DKA requiring emergency treatment in the year before CSII and 4 episodes (4 per 100 patient-years) after transition to pump.Conclusions. CSII is a durable and effective means of optimizing glycemic control in very young patients with type 1 diabetes and may be superior to multiple daily injections in minimizing the risk of severe hypoglycemia in this age group. Employment of paid caregivers does not preclude safe and effective use of CSII.