Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years.
Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years.
复制标题
1 型糖尿病青少年的胰岛素泵使用和血糖控制：两年内胰岛素输送方法变化的预测因素。
DOI：
10.1111/pedi.12221
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发表时间：
2015
影响因子：
3.4
通讯作者：
Hood,KoreyK
中科院分区：
文献类型：
--
作者：
Wong,JeniseC;Dolan,LawrenceM;Yang,TonyT;Hood,KoreyK
很少有研究探讨胰岛素泵使用的持久性，也没有研究探讨抑郁症和胰岛素泵停用之间的联系。为了检查抑郁症状[通过儿童抑郁量表（CDI）测量]，胰岛素输送方法和血红蛋白A1 c（A1 c）之间的关系，使用混合模型，数据来自150名患有1型糖尿病（T1 D）的青少年，每6个月随访一次，持续2年。与基线时每日多次注射（MDI）相比，在使用胰岛素泵的63%患者中，非少数民族、有大学学历、私人保险和家中有两名护理人员的比例较高（p ≤ 0.01）。在调整时间、性别、年龄、T1 D病程、血糖监测频率、种族、保险、护理人员数量和教育后，基线胰岛素泵使用与平均A1 c降低-0.79%相关[95%置信区间（CI）：-1.48，-0.096; p = 0.03]。对于那些在基线时使用泵，但在研究期间转换为MDI的患者（n = 9），平均A1 c比未转换输送方法的患者高1.38%（95% CI：0.68，2.08; p < 0.001）。CDI增加10分与A1 c增加0.39%相关（95% CI：0.16，0.61; p = 0.001），与泵使用无关。关于CDI评分与胰岛素输注方法改变之间的时间关系，既往较高的CDI评分与从胰岛素泵转换为MDI相关（比值比= 1.21; 95% CI：1.05，1.39; p = 0.007）。临床医生应了解抑郁症状、胰岛素给药方式的改变与血糖控制之间的关系。
Few studies have explored durability of insulin pump use, and none have explored the link between depression and pump discontinuation. To examine the relationship between depressive symptoms [measured by the Children's Depression Inventory (CDI)], method of insulin delivery, and hemoglobin A1c (A1c), mixed models were used with data from 150 adolescents with type 1 diabetes (T1D) and visits every 6 months for 2 years. Of the 63% who used a pump, compared with multiple daily injections (MDI) at baseline, there were higher proportions who were non‐minorities, had caregivers with a college degree, private insurance, and two caregivers in the home (p ≤ 0.01). After adjusting for time, sex, age, T1D duration, frequency of blood glucose monitoring, ethnicity, insurance, and caregiver number and education, baseline pump use was associated with −0.79% lower mean A1c [95% confidence interval (CI): −1.48, −0.096; p = 0.03]. For those using a pump at baseline, but switching to MDI during the study (n = 9), mean A1c was 1.38% higher (95% CI: 0.68, 2.08; p < 0.001) than that for those who did not switch method of delivery. A 10‐point increase in CDI was associated with a 0.39% increase in A1c (95% CI: 0.16, 0.61; p = 0.001), independent of pump use. Regarding the temporal relationship between CDI score and changing method of insulin delivery, prior higher CDI score was associated with switching from pump to MDI (odds ratio = 1.21; 95% CI: 1.05, 1.39; p = 0.007). Clinicians should be aware of the associations between depressive symptoms, change in insulin delivery method, and the effect on glycemic control.