Impact of school-supervised ultra-long-acting basal insulin injections on ketosis in youth with T1D and elevated haemoglobin A1c: A pilot study.
Impact of school-supervised ultra-long-acting basal insulin injections on ketosis in youth with T1D and elevated haemoglobin A1c: A pilot study.
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学校监督下的超长效基础胰岛素注射对患有 T1D 和血红蛋白 A1c 升高的青少年酮症的影响：一项试点研究。
DOI：
10.1111/dme.15123
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
VanName,Michelle
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作者：
Nally,LauraM;Sherr,JenniferL;Tichy,Eileen;Weyman,Kate;Urban,Andrea;Shabanova,Veronika;McCollum,Sarah;Steffen,Amy;Tamborlane,WilliamV;VanName,Michelle
背景在1型糖尿病（T1 D）青少年中，高血红蛋白A1 c（HbA 1c）水平与糖尿病酮症酸中毒（DKA）风险增加相关。目的本研究旨在探讨每日在学校监督下进行基础胰岛素注射是否可行，以及是否可降低HbA 1c水平高的儿童和青少年早晨酮症的风险。我们假设，监督甘精胰岛素和德谷胰岛素将降低酮症的风险，德谷胰岛素的长期作用将在连续几天的无监督injection.Materials和MethodsAfter 2-4周的磨合，青少年（10-18岁，HbA 1c ≥ 8.5%）管理T1 D与注射后，被随机分配到学校监督的德谷胰岛素或甘精胰岛素给药4个月。学校护士观察每日血液β-羟基丁酸（BHB）和葡萄糖检查。结果分析了28名青年（年龄14. 3 ± 2. 3岁，HbA 1c 11. 4 ± 1. 9%，64% F）的数据。在学校监督下注射两种基础胰岛素1-4天，逐渐降低了BHB升高的参与者百分比。甘精胰岛素组在家中接受2天无监督基础胰岛素给药后BHB升高（≥0.6 mmol/L）的受试者百分比高于德谷胰岛素组，但p值较高（17.2% vs. 9.0%，p = 0.3）。HbA 1c在两组中均无变化。讨论在糖尿病酮症酸中毒高危的T1 D青少年中，每日监督长效胰岛素给药可降低随后上学日酮水平升高的概率，无论基础胰岛素类型如何。更大的样本量可能已经证明，德谷的更长的作用曲线将提供额外的保护，从酮症天不上学.ConclusionEngaging学校为基础的照顾者在管理青少年T1 D注射胰岛素可能会减少临床显着酮症，并尽量减少糖尿病的急性并发症。
BackgroundIn youth with type 1 diabetes (T1D), high haemoglobin A1c (HbA1c) levels are associated with an increased risk for diabetic ketoacidosis (DKA).AimsThis study examined whether daily school‐supervised basal insulin injections were feasible and if they reduced the risk of morning ketosis in children and adolescents with high HbA1c levels. We hypothesized that supervised glargine and degludec would reduce the risk of ketosis and that the prolonged action of degludec would protect from ketosis after consecutive days of unsupervised injections.Materials & MethodsAfter a 2–4‐week run‐in, youth (10–18 years, HbA1c ≥ 8.5%) managing T1D with injections were randomized to school‐supervised administration of degludec or glargine for 4 months. School nurses observed daily blood β‐hydroxybutyrate (BHB) and glucose checks. During COVID closures, the research team supervised procedures remotely.ResultsData from 28 youth (age 14.3 ± 2.3 years, HbA1c 11.4 ± 1.9%, 64% F) were analysed. School‐supervised injections of both basal insulins for 1–4 days progressively lowered the percent of participants with elevated BHB. The percent of participants with elevated BHB (≥0.6 mmol/L) after 2 days of unsupervised basal insulin doses at home was greater in the glargine than degludec group but had a highp‐value (17.2% vs. 9.0%,p= 0.3). HbA1c was unchanged in both groups.DiscussionIn youth with T1D at high risk for DKA, daily supervised long‐acting insulin administration decreased the probability of elevated ketone levels on subsequent school days, regardless of basal insulin type. A larger sample size may have demonstrated that the longer action profile of degludec would offer additional protection from ketosis during days of not attending school.ConclusionEngaging school‐based caregivers in management of youth with T1D on injected insulin may decrease clinically significant ketosis and minimize acute complications of diabetes.