The durability and effectiveness of sensor-augmented insulin pump therapy in pediatric and young adult patients with type 1 diabetes
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Purpose: Despite the prevalent use of insulin pump therapy worldwide, few studies have been conducted among young patients with type 1 diabetes (T1D) in Korea. We investigated the durability and effectiveness of insulin pump therapy among Korean pediatric and young adult patients with T1D. Methods: This study included 54 patients with T1D diagnosed at pediatric ages (range, 1.1–14.1 years) who initiated insulin pump therapy during 2016–2019 at Seoul National University Children's Hospital and Seoul National University Bundang Hospital. Clinical and biochemical data, including anthropometric measurements, insulin dose, and glycated hemoglobin (HbA1c) levels were obtained from T1D diagnosis to last follow-up. Results: Forty-four patients (81.5%) continued insulin pump therapy with a median pump use duration of 2.9 years (range, 0.2–3.5 years); 10 discontinued the therapy within 12 months (<1 month, n=6; 1–6 months, n=1; and 6–12 months, n=3) due to physical interferences or financial problems. Older age (≥10 years of age) and longer diabetes duration (≥2 years) at the initiation of pump therapy were associated with discontinuation (P<0.05 for both). For patients continuing pump therapy, HbA1c levels significantly decreased after 1 year of therapy (from 8.9% to 8.1%, P<0.001) without changes in the body mass index z-scores or insulin dose. Although 4 patients experienced diabetic ketoacidosis, all recovered without complications. Conclusion: Insulin pump therapy was effective in improving glycemic control in T1D patients during 12 months of treatment. Early initiation of insulin pump therapy after T1D diagnosis was helpful for continuing therapy.
Abstract
Purpose: Despite the prevalent use of insulin pump therapy worldwide, few studies have been conducted among young patients with type 1 diabetes (T1D) in Korea. We investigated the durability and effectiveness of insulin pump therapy among Korean pediatric and young adult patients with T1D. Methods: This study included 54 patients with T1D diagnosed at pediatric ages (range, 1.1–14.1 years) who initiated insulin pump therapy during 2016–2019 at Seoul National University Children's Hospital and Seoul National University Bundang Hospital. Clinical and biochemical data, including anthropometric measurements, insulin dose, and glycated hemoglobin (HbA1c) levels were obtained from T1D diagnosis to last follow-up. Results: Forty-four patients (81.5%) continued insulin pump therapy with a median pump use duration of 2.9 years (range, 0.2–3.5 years); 10 discontinued the therapy within 12 months (<1 month, n=6; 1–6 months, n=1; and 6–12 months, n=3) due to physical interferences or financial problems. Older age (≥10 years of age) and longer diabetes duration (≥2 years) at the initiation of pump therapy were associated with discontinuation (P<0.05 for both). For patients continuing pump therapy, HbA1c levels significantly decreased after 1 year of therapy (from 8.9% to 8.1%, P<0.001) without changes in the body mass index z-scores or insulin dose. Although 4 patients experienced diabetic ketoacidosis, all recovered without complications. Conclusion: Insulin pump therapy was effective in improving glycemic control in T1D patients during 12 months of treatment. Early initiation of insulin pump therapy after T1D diagnosis was helpful for continuing therapy.
참고문헌 (38)
- DiMeglio LA, "Type 1 diabetes", Lancet, 391, pp.2449~2462 (2018)
- "American Diabetes A. 6. Glycemic targets: standards of medical care in diabetes-2020", Diabetes Care, 43, pp.S66~S76 (2020)
- Tauschmann M, "Technology in the management of type 1 diabetes mellitus-current status and future prospects", Nat Rev Endocrinol, 14, pp.464~475 (2018)
- Sherr JL, "ISPAD Clinical Practice Consensus Guidelines 2018 : diabetes technologies", Pediatr Diabetes, 19(Suppl 27), pp.302~325 (2018)
- Bergenstal RM, "Threshold-based insulin-pump interruption for reduction of hypoglycemia", N Engl J Med, 369, pp.224~232 (2013)
- DiMeglio LA, "ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes", Pediatr Diabetes, 19(Suppl 27), pp.105~114 (2018)
- "American Diabetes A. 13. Children and adolescents:standards of medical care in diabetes-2020", Diabetes Care, 43, pp.S163~S182 (2020)
- Sherr JL, "Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries", Diabetologia, 59, pp.87~91 (2016)
- Willi SM, "Racial-ethnic disparities in management and outcomes among children with type 1 diabetes", Pediatrics, 135, pp.424~434 (2015)
- Kim JH, "Increasing incidence of type 1 diabetes among Korean children and adolescents : analysis of data from a nationwide registry in Korea", Pediatr Diabetes, 17, pp.519~524 (2016)
- Mayer-Davis EJ, "Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012", N Engl J Med, 376, pp.1419~1429 (2017)
- "Insulin infusion system approval No. 16-264" (2016)[URL]
- "Ministry of Health and Welfare Notification No. 2019-295" (2019)[URL]
- 김재현, "The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects", Clinical and Experimental Pediatrics, 61(5), pp.135~149 (2018), 대한소아청소년과학회
- Wolfsdorf JI, "ISPAD Clinical Practice Consensus Guidelines 2018 : diabetic ketoacidosis and the hyperglycemic hyperosmolar state", Pediatr Diabetes, 19(Suppl 27), pp.155~177 (2018)
- 송선옥, "Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System", Diabetes and Metabolism Journal, 38(5), pp.395~403 (2014), 대한당뇨병학회[DOI]
- Hofer SE, "Discontinuation of insulin pump treatment in children, adolescents, and young adults. A multicenter analysis based on the DPV database in Germany and Austria", Pediatr Diabetes, 11, pp.116~121 (2010)
- de Vries L, "Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes", Pediatr Diabetes, 12, pp.506~512 (2011)
- Wong JC, "Evaluation of pump discontinuation and associated factors in the T1D exchange clinic registry", J Diabetes Sci Technol, 11, pp.224~232 (2017)
- Wong JC, "Insulin pump use and glycemic control in adolescents with type 1 diabetes:Predictors of change in method of insulin delivery across two years", Pediatr Diabetes, 16, pp.592~599 (2015)
- Shulman R, "Insulin pump use and discontinuation in children and teens : a population-based cohort study in Ontario, Canada", Pediatr Diabetes, 18, pp.33~44 (2017)
- Chamberlain JJ, "Do perceptions of insulin pump usability impact attitudes toward insulin pump therapy? A pilot study of individuals with type 1 and insulin-treated type 2 diabetes", J Diabetes Sci Technol, 9, pp.105~110 (2015)
- Wood JR, "Durability of insulin pump use in pediatric patients with type 1 diabetes", Diabetes Care, 29, pp.2355~2360 (2006)
- Lin MH, "Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1diabetes", Diabetes Technol Ther, 15, pp.929~934 (2013)
- Berghaeuser MA, "Continuous subcutaneous insulin infusion in toddlers starting at diagnosis of type 1 diabetes mellitus. A multicenter analysis of 104 patients from 63 centres in Germany and Austria", Pediatr Diabetes, 9, pp.590~595 (2008)
- Ramchandani N, "Insulin pump therapy from the time of diagnosis of type 1 diabetes", Diabetes Technol Ther, 8, pp.663~670 (2006)
- Brancato D, "The effectiveness and durability of an early insulin pump therapy in children and adolescents with type 1diabetes mellitus", Diabetes Technol Ther, 16, pp.735~741 (2014)
- Seereiner S, "Attitudes towards insulin pump therapy among adolescents and young people", Diabetes Technol Ther, 12, pp.89~94 (2010)
- Zimmerman C, "Advances in type 1 diabetes technology over the last decade", Eur Endocrinol, 15, pp.70~76 (2019)
- Weissberg-Benchell J, "Insulin pump therapy : a meta-analysis", Diabetes Care, 26, pp.1079~1087 (2003)
- Benkhadra K, "Continuous subcutaneous insulin infusion versus multiple daily injections in individuals with type 1diabetes : a systematic review and meta-analysis", Endocrine, 55, pp.77~84 (2017)
- Jeitler K, "Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis", Diabetologia, 51, pp.941~951 (2008)
- Karges B, "Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes", JAMA, 318, pp.1358~1366 (2017)
- Birkebaek NH, "Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA1c and other predictors of increasing BMISDS", Pediatr Diabetes, 19, pp.1198~1205 (2018)
- Hanas R, "A 2-yr national population study of pediatric ketoacidosis in Sweden:predisposing conditions and insulin pump use", Pediatr Diabetes, 10, pp.33~37 (2009)
- Maahs DM, "Rates of diabetic ketoacidosis:international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany", Diabetes Care, 38, pp.1876~1882 (2015)
- Ross PL, "Clinical review : insulin pump-associated adverse events in adults and children", Acta Diabetol, 52, pp.1017~1024 (2015)
- Pfutzner A, "Using insulin infusion sets in csii for longer than the recommended usage time leads to a high risk for adverse events: results from a prospective randomized crossover study", J Diabetes Sci Technol, 9, pp.1292~1298 (2015)