Long-term Follow-up And Efficacy Analysis Of Continuous Subcutaneous Insulin Infusion In Type 1 Diabetes Mellitus Children In Qingdao

Objective: To investigate glycemic control in children with Type 1 Diabetes Mellitus(T1DM)who used of Insulin pump(Continuous Subcutaneous Insulin Infusion,CSII)in Qingdao area,to study the CSII curative effect in T1 DM children with long-term therapy,to analyze the influence factors associated with efficacy,and to provide theoretical guidance for application of CSII in long-term therapy and follow-up management.Methods:From January 2019 to June 2019,60 T1 DM children with Medtronic 722 CSII for more than 6 months in the outpatient department of endocrinology of Qingdao women and children’s hospital,who were under 18 years old and lived in Qingdao for a long time,were followed up with questionnaires to understand the general condition and treatment-related data.Results:(1)Questionnaires were sent to 60 T1 DM children who had been followed up for a long time in the outpatient department of endocrinology of Qingdao Women and Children’s hospital,and 40 valid questionnaires were recovered,with an effective recovery rate of 66.7%.There were 21 were male and 19 were female;the age ranged from 1.92 to 17.25 years,the average age was 11.23±3.95 years;the onset age ranged from 0.83 to 16.42 years,average onset age was 7.25±3.43 years;the course of disease ranged from 0.75 to 10.08 years,the median course of disease was 3.71(1.83,5.57)years;and the pumping time ranged from 0.60 to 9.00 years,the median pumping time was 2.67(1.02,4.65)years.(2)Among the 40 cases,27(67.5%)children were for more stable blood sugar control,9(22.5%)children for fewer injections,and 4(10.0%)children for a more liberal diet.In the process of CSII treatment,6(15.0%)children had CSII exclusion because of inconvenience,but they still chose to continue treatment.(3)The Hemoglobin A1c(HbA1c)was(7.12±1.11)% in children with T1 DM who were treated with CSII,and the overall control level was good,which was significantly lower than the HbA1c(9.58±2.08)% before CSII treatment.There was a significant difference in the HbA1 c level before and after CSII treatment(t=7.315,P<0.05).The daily insulin dosage was [0.91(0.86,0.94)] IU/kg before treatment,after treatment the daily insulin dosage was [0.80(0.66,0.88)] IU/kg,the insulin dosage decreased,there was significant difference in dosage before and after treatment(z=-5.514,P<0.05).All the 40 children had hypoglycemia before CSII therapy,among which 7 had severe hypoglycemia,no severe hypoglycemia occurred after CSII therapy,and 6 children had hypoglycemia.There were 24(60.0%)children with ketoacidosis,and there were 2 children of ketoacidosis in puberty developed children after CSII therapy.(4)The control of blood glucose in preschool children was better than that in school-age and adolescence,the difference was statistically significant(t=0.129,P<0.05).HbA1 c in children who followed the diabetic diet was significantly lower than that in children who did not follow the diabetic diet,the difference was statistically significant(t=0.016,P<0.05).The blood glucose control of children who exercised more than 30 minutes per day was better than that of children who exercised less than 30 minutes per day,the difference was statistically significant(F=5.626,P<0.05).Children who insisted on returning to the hospital for 3～6 months had better blood glucose control than those with returned to the hospital for more than 6 months,the difference was statistically significant(F=4.084,P<0.05).Children with self-monitoring frequency≥6 times/day had better blood glucose control than children with self-monitoring frequency<6 times/day,the difference was statistically significant(F=5.772,P<0.05).There were no significant differences in HbA1 c level before and after CSII therapy,among gender,glucose manager,manager’s education background and family income,etc.(t=2.211,F=1.100,F=1.895,F=0.191,P >0.05).Conclusions:After the CSII therapy,the glycemic control level of T1 DM children in Qingdao area was effectively controlled,and HbA1 c was significantly reduced.In addition,both insulin dosage and hypoglycemia and ketoacidosis also decreased.Good diet control,regular exercise,regular follow-up and especially high frequency blood glucose monitoring are associated with better glycemic control.