| Objective:To investigate the glycemic control in paediatric patients with type1 diabetes mellitus(T1DM)and long-term insulin pump therapy,explore the major factors.Methods:Collected 73 T1DM patients,who were treated with an insulin pump for more than 3 months,were from Qingdao aged 6-18 years.The patients’Clinical data include general information(age,duration of pumping,gender,BMI,age of onset,duration of disease,starting pump treatment age),self-management information(diabetes diet performance,weekly exercise time,frequency of self blood glucose monitoring,frequency of return visits,advanced functional usage of the pump,frequency of Hb A1c monitoring,frequency of hypoglycemia),how much insulin doses(total daily insulin,basic doses,daily preprandial doses,basic doses/total daily doses),laboratory data(Hb A1c values in the last month,average fasting blood glucose,2h postprandial blood glucose in the last week,last Hb A1c before pumping,mean fasting blood glucose,2h postprandial blood glucose in 3-6months before pumping),and family status(annual household income,highest level among parents).According to the recommendations of the American Diabetes Association(ADA)guidelines in 2014,patients with T1DM(<18 years of age)had Hb A1c control of<7.5%.According to Hb A1c value in the last mo nth,patients were divided into two groups:blood glucose control is at target group(Hb A1c<7.5%),blood glucose control is not at target group(Hb A1c≥7.5%),Logistic regression model to analyze related factors.Results:(1)Due to acute complications exclude two case,the current stop pump therapy to exclude three cases,the final study included 68 patients,31 males(45.6%)and 37 females(54.4%).The current median age was 14.0(11.0~16.0)years old,mean onset age was 8.59±3.52 years,median cour se of disease was 48.0(36.0~72.0)months,average starting pump treatment age was 10.97±3.43 years,median pumping time was 24.0(12.0~36.0)months,t he average BMI 19.25±3.08kg/m~2.(2)The average Hb A1c before the treatment with insulin pump was(9.46±2.46)%,the Hb A1c compliance rate was 28%(19/68),and the non-compliance rate was 72%,of which Hb A1c≥9%was as high as 58.8%.The most recent average Hb A1c follow-up after treatment with insulin pump was(8.38±1.55)%,the compliance rate was 38%(26/68),the non-compliance rate was 62%,and the proportion of Hb A1c≥9%was 23.6%.It was significantly lower than before the pump treatment.There was significant difference in the Hb A1c level and blood glucose compliance rate before and after treatment with insulin pump(t=-5.76,χ2=10.315,P<0.05).(3)Compared with patients with blood glucose control substandard group,the patients with blood glucose control compliance group had lower average age,younger age of initial pump treatment,lower fasting blood glucose and postprandial blood glucose levels in the last week,and higher highest education among parents.The frequency of return visits is higher,the frequency of self-monitoring blood glucose is higher,the family’s annual in come is higher,various functions of the pump can be flexibly used,and diabetes diet can be adhered to.(4)Logistic regression analysis adjusting the age,the age of the starting pump therapy,last week’s average fasting blood glucose,highest level of ed ucation among parents,frequency of referral and hypoglycemia interference,revealed an odds ratio of 0.285(95%CI:0.093~0.880,P=0.03)for the average postprandial 2h blood glucose in the last week,an OR of 1.939(95%CI:1.050~3.581,P=0.03)for self-monitoring blood glucose(SMBG)frequency,an OR of 0.038(95%CI:0.002~0.628,P=0.02)for the flexibility to use various functions of the pump,an OR of 0.070(95%CI:0.006~0.886,P=0.04)for adhering to diabetic diet and an OR of0.019(95%CI:0.001~0.392,P=0.01)for higher annual household income.Conclusions:Good postprandial blood glucose management,adhering to diabetic diet,higher self-monitoring of blood glucose to appropriate adjust the insulin doses,flexible using the functions of insulin pump are controllable factors for paediatric patients with T1DM on an insulin pump. |
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