Erişkin Tip 1 Diabetes Mellitus Hastalarında İnsülin Pompasının Etkinliği

Year 2021, Volume: 7 Issue: 1, 111 - 118, 01.01.2021

Nusret Yılmaz Hakan Doğruel Şefika Dalkıran Ramazan Sarı Mustafa Kemal Balcı

Abstract

Amaç: Bu çalışmanın amacı, tip 1 diabetes mellitus DM hastalarında insülin pompası ile sürekli cilt altı insülin infüzyonu SCİİ tedavisinin etkinliğini değerlendirmektir.Gereç ve Yöntemler: Tip 1 DM tanısı ile izlenen ve insülin pompası ile sürekli cilt altı insülin infüzyonu yapılan hastaların SCİİ grubu verileri retrospektif olarak incelenerek hastaların pompa öncesi ve sonrası verileri karşılaştırıldı. Ek olarak; çoklu insülin enjeksiyonu ÇİE tedavisi alan tip 1 DM hastalarından bir grup ÇİE grubu daha oluşturularak bu hastaların da verileri retrospektif olarak incelendi ve SCİİ grubu ile ÇİE grubunun verileri karşılaştırıldı.Bulgular: Çalışmaya 49’u SCİİ grubunda, 45’i ise ÇİE grubunda olmak üzere toplam 94 hasta alındı. SCİİ grubunda, pompa tedavisi sonrasında pompa öncesine göre HBA1C düzeyinde anlamlı düzeyde bir azalma saptandı Sırası ile %8,8 ±1,4 ve %7,8 ±1,2 p

Keywords

İnsülin pompası, İntensif insülin tedavisi, Sürekli cilt altı insülin infüzyonu, Tip 1 diabetes mellitus

Effectiveness of Insulin Pump in Adult Type 1 Diabetes Mellitus Patients

Abstract

Objective: The aim of the study is to evaluate the effectiveness of continuous subcutaneous insulin infusion CSII treatment with the insulin pump in type 1 diabetes mellitus DM patients.Material and Methods: We retrospectively analyzed the data of patients who were being followed up with the diagnosis of type 1 DM and receiving continuous subcutaneous insulin infusion treatment with insulin pump CSII group , and compared the pre-pump and post-pump data. In addition, we formed a group of type 1 DM patients who received multiple daily insulin injection MDII treatment and retrospectively analyzed the data. The data of the CSII group and the MDII group were also compared.Results: 94 patients 49 in the CSII group and 45 in the MDII group were included in the study in total. We found a significant decrease in the HBA1C level by comparing the pre-pump and postpump data in the CSII group 8.8% ± 1.4 and 7.8% ± 1.2 , respectively, p

Keywords

Insulin pump, Intensive insulin treatment, Continuous subcutaneous insulin infusion, Type 1 diabetes mellitus

References

• Almogbel E. Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study. J Family Med Prim Care 2020; 9:1013-9.
• Melmed S, Koenig R, Rosen C, Auchus R, Goldfine A. Williams textbook of endocrinology, 14th Edition, E-Book, Elsevier, 2020.
• Abaci A, Atas A, Unuvar T, Demir K, Bober E, Büyük- gebiz A. A comparison of multiple daily insulin therapy with continuous subcutaneous insulin infusion therapy in adolescents with type 1 diabetes mellitus: A single-center experience from Turkey. J Pediatr Endocrinol Metab 2009; 22:539-46.
• Association AD. 15. Diabetes care in the hospital: Stan- dards of medical care in diabetes-2020. Diabetes Care 2020; 43:193-202.
• Cander S, Kıyıcı S, Deligönül A, Gül ÖÖ, Ünal OK, Sakallı M, Tuncel E, İmamoğlu Ş. Cilt altı insülin infüz- yon tedavisinin tip 1 diyabetik hastalarda tedavi etkinliği. Turkish Journal of Endocrinology & Metabolism 2010; 14:80-4.
• White N, Cleary P, Dahms W, Goldstein D, Malone J, Tamborlane W. Diabetes Control and Complications T rial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) research group. Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the diabetes control and complications trial (DCCT). J Pediatr 2001; 139:804-12.
• Association AD. Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the diabe- tes control and complications trial cohort. Diabetes Care 1999; 22:99-111.
• Yeh HC, Brown TT, Maruthur N, Ranasinghe P, Berger Z, Suh YD, Wilson LM, Haberl EB, Brick J, Bass EB. Comparative effectiveness and safety of methods of insu- lin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med 2012; 157:336-47.
• Al HAA, Robert AA, Al MA. Dawish. Skin-related comp- lications among adolescents with type 1 diabetes using insulin pump therapy. Clin Med Insights Endocrinol Diabetes 2018; 11:1-5
• Ross P, Milburn J, Reith D, Wiltshire E, Wheeler B. Clinical review: Insulin pump-associated adverse events in adults and children. Acta Diabetol 2015; 52:1017-24.
• Bode BW, Sabbah HT, Gross TM, Fredrickson LP, Davidson PC. Diabetes management in the new millen- nium using insulin pump therapy. Diabetes Metab Res Rev Suppl 2002; 1:14-20.
• Karges B, Schwandt A, Heidtmann B, Kordonouri O, Binder E, Schierloh U, Boettcher C, Kapellen T, Rosen- bauer J, Holl RW. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, keto- acidosis, and glycemic control among children, adoles- cents, and young adults with type 1 diabetes. JAMA 2017; 318:1358-66.
• Maiorino MI, Bellastella G, Casciano O, Cirillo P, Simeon V, Chiodini P, Petrizzo M, Gicchino M, Romano O, Caruso P. The effects of subcutaneous insulin infusion versus multiple insulin injections on glucose variability in young adults with type 1 diabetes: The 2-year follow-up of the observational METRO study. Diabetes Technol Ther 2018; 20:117-26.
• Pala L, Dicembrini I, Mannucci E. Continuous subcu- taneous insulin infusion vs modern multiple injection regimens in type 1 diabetes: An updated meta-analysis of randomized clinical trials. Acta Diabetol 2019; 56(9):973- 80.
• Rodrigues IAS, Reid HA, Ismail K, Amiel SA. Indicati- ons and efficacy of continuous subcutaneous insulin infu- sion (CSII) therapy in Type 1 diabetes mellitus: A clinical audit in a specialist service. Diabet Med 2005; 22:842-9.
• Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; An observational study of 100 consecutive patients follo- wed for a mean of 2 years. Diabet Med 2002; 19:746-51.
• McMahon SK, Airey FL, Marangou DA, McElwee KJ, Carne CL, Clarey AJ, Davis EA, Jones TW. Insulin pump therapy in children and adolescents: Improvements in key parameters of diabetes management including quality of life. Diabet Med 2005; 22:92-6.
• Scheidegger U, Allemann S. Continuous subcutaneous insulin infusion therapy: Effects on quality of life. Swiss Med Wkly 2007; 137:476-82
• DeVries, JH, Snoek FJ, Kostense PJ, Masurel N, Heine RJ. A randomized trial of continuous subcutaneous insulin infusion and intensive injection therapy in type 1 diabetes for patients with long-standing poor glycemic control. Diabetes Care 2002; 25:2074-80.
• Chantelau E, Spraul M, Mühlhauser I, Gause R, Berger M. Long-term safety, efficacy and side-effects of continu- ous subcutaneous insulin infusion treatment for type 1 (insulin-dependent) diabetes mellitus: A one centre expe- rience. Diabetologia 1989; 32:421-6.
• Andersen HU, Hangaard S, Hommel E, Ridderstråle M. Six-year follow-up after insulin pump initiation: HbA1c is significantly reduced without weight gain. J Diabetes Sci Technol 2018; 12(2):535-6.
• Petrovski G, Zivkovic M, Stratrova SS, Todorova BJ. Type 1 diabetes and long-term continuous subcutane- ous insulin infusion therapy: A 10-year experience from Macedonia. Diabetes Technol Ther 2017; 19:739-43.
• Quirós C, Viñals C, Giménez M, Roca D, Conget I. Assessment of the effectiveness of long-term insulin pump therapy using a combined goal of HbA1c decrease and absence of severe hypoglycemia. Endocrinol Diabetes Nutr 2019; 66:534-9.
• Kekäläinen P, Tirkkonen H, Laatikainen T. How are metabolic control targets of patients with type 1 diabe- tes mellitus achieved in daily practice in the area with high diabetes prevalence? Diabetes Res Clin Pract 2016; 115:9-16.
• McKnight, J, Wild S, Lamb M, Cooper M, Jones T, Davis E, Hofer S, Fritsch M, Schober E, Svensson J. Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: An international comparison. Diabet Med 2015; 32:1036-50.
• Clements M, Matuleviciene V, Attvall S, Ekelund M, Pivodic A, Dahlqvist S, Fahlén M, Haraldsson B, Lind M. Predicting the effectiveness of insulin pump therapy on glycemic control in clinical practice: A retrospective study of patients with type 1 diabetes from 10 outpatient diabetes clinics in Sweden over 5 years. Diabetes Technol Ther 2015; 17:21-8.
• Pickup JC, Yemane N, Brackenridge A, Pender S. Nonmetabolic complications of continuous subcutaneous insulin infusion: A patient survey. Diabetes Technol Ther 2014; 16:145-9.
• van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G. Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: A randomized controlled trial. Diabetes Tech- nol Ther 2011; 13:607-614.
• Hoogma R, Schumicki D. Safety of insulin glulisine when given by continuous subcutaneous infusion using an exter- nal pump in patients with type 1 diabetes. Horm Metab Res 2006; 38:429-33.
• Kerr D, Morton J, Whately-Smith C Everett J, Begley JP. Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continu- ous subcutaneous insulin infusion catheters using low flow rates. J Diabetes Sci Technol 2008; 2:450-5.
• Bode BW, Steed RD, Davidson PC. Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type I diabetes. Diabetes Care 1996; 19(4):324-7.
• Rudolph JW, Hirsch IB. Assessment of therapy with continuous subcutaneous insulin infusion in an academic diabetes clinic. Endocr Pract 2002; 8(6):401-5.
• Handelsman Y, Mechanick J, Blonde L, Grunberger G, Bloomgarden Z, Bray G, Dagogo-Jack S, Davidson J, Einhorn D, Ganda O. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011; 17:1-53.
• Prašek M, Božek T, Metelko Z. Continuous subcutaneous insulin infusion (CSII). Diabetologia Croat 2003; 32:111- 24.
• Hanas R, Adolfsson P. Insulin pumps in pediatric routine care improve long‐term metabolic control without incre- asing the risk of hypoglycemia. Pediatr Diabetes 2006; 7:25-31.