Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery
Young Children Have Higher Variability of Insulin Requirements: Observations During Hybrid Closed-Loop Insulin Delivery
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DOI：
10.2337/dc18-2625
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发表时间：
2019-07-01
期刊：
影响因子：
16.2
通讯作者：
Hovorka, Roman
中科院分区：
文献类型：
--
作者：
Dovc, Klemen;Boughton, Charlotte;Hovorka, Roman
目的 量化白天和夜间闭环胰岛素输送期间胰岛素需求与年龄相关的变异性。研究设计和方法 我们回顾性分析了混合闭环研究的数据，这些研究涉及患有 1 型糖尿病的幼儿（1-6 岁，n = 20）、儿童（7-12 岁，n = 21）、青少年（13-17 岁，n = 15）和成人（>18 岁，n = 58）。变异系数量化了 3 周无限制生活混合闭环使用期间胰岛素需求的变异性。结果 对 114 名参与者 2,365 个晚上和 2,367 天的数据进行了分析。与成人相比，幼儿的胰岛素输送变异系数较高（夜间平均差异 10.7 个百分点 [95% CI 2.9-18.4]，P = 0.003；白天 6.4 个百分点 [95% CI 2.0-10.9]，P = 0.002），并且与青少年相比（夜间平均差异 10.2 个百分点 [95% CI]） 0.0-20.4]，P = 0.049；白天 7.0 个百分点 [95% CI 1.1-12.8]，P = 0.014）。结论 由于胰岛素需求的较高变异性，幼儿糖尿病管理变得复杂，支持在这一弱势群体中快速采用闭环临床实践。
OBJECTIVE To quantify age-related variability of insulin needs during day and night closed-loop insulin delivery. RESEARCH DESIGN AND METHODS We retrospectively analyzed data from hybrid closed-loop studies involving young children (1-6 years old, n = 20), children (7-12 years, n = 21), adolescents (13-17 years, n = 15), and adults (>18 years, n = 58) with type 1 diabetes. The coefficient of variation quantified variability of insulin needs during 3 weeks of unrestricted-living hybrid closed-loop use. RESULTS Data from 2,365 nights and 2,367 days in 114 participants were analyzed. The coefficient of variation of insulin delivery was higher in young children compared with adults (mean difference at nighttime 10.7 percentage points [95% CI 2.9-18.4], P = 0.003; daytime 6.4 percentage points [95% CI 2.0-10.9], P = 0.002) and compared with adolescents (mean difference at nighttime 10.2 percentage points [95% CI 0.0-20.4], P = 0.049; daytime 7.0 percentage points [95% CI 1.1-12.8], P = 0.014). CONCLUSIONS Diabetes management in young children is complicated by higher variability in insulin requirements, supporting fast-track clinical practice adoption of closed-loop in this vulnerable population.