Noćna hipoglikemija – vodeća indikacija za terapiju inzulinskom crpkom u odraslih
| Autor: | Maja Baretić, Ivana Kraljević, Ivana Pavlić Renar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Dijabetes melitus
tip 1 – komplikacije Hipoglikemija – prevencija i kontrola Inzulin – primjena i doziranje Inzulin sustavi za infuziju Inzulinska crpka Odrasla osoba nutritional and metabolic diseases Diabetes mellitus type 1 – complications Hypoglycemia prevention and control Insulin – pump administration and dosage Insulin infusion systems Insulin pump Adult |
| Zdroj: | Acta clinica Croatica Volume 55. Issue 1. |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | The aim was to determine which adult type 1 diabetic patient receiving multiple daily injection therapy is the most appropriate candidate for insulin pump therapy, while taking into consideration limited insulin pump affordability in Croatia. A total of 145 type 1 diabetic patients (52% diagnosed in adult age) were monitored at the Department of Endocrinology, Clinical Department of Internal Medicine, Zagreb University Hospital Center from 2009 to 2014. Twenty-one patients started insulin pump therapy in adulthood (seven men and 14 women, median age 27). Five patients had chronic complications (retinopathy in two, polyneuropathy in one, and both nephropathy and retinopathy in two patients). The median HbA1c at the initiation of pump therapy was 6.95% versus 6.5% after 1 year of pump therapy. Patients were stratified according to indications for insulin pump therapy (frequent and/or severe hypoglycemia, specific lifestyle, having not reached glycemic goals despite adherence/labile diabetes, and preconception). Patients could meet more than one criterion. Initially, the occurrence of hypoglycemia was analyzed by 6-day continuous glucose monitoring, while re-evaluation was done after collecting history data at 1 year ± 3 months. Initially, all patients had a median of 5 hypoglycemias/6 days (30% nocturnal) versus 1 hypoglycemia/6 days (without nocturnal) after 1 year. The Wilcoxon signed-rank test yielded a statistically significant difference in hypoglycemic events, nocturnal hypoglycemia and HbA1c. Patients commencing insulin pump therapy due to hypoglycemia initially had median HbA1c of 6.7% with 7 hypoglycemia/6 days (50% nocturnal). After one year, median HbA1c was 6% with 1 hypoglycemia/6 days (without nocturnal). In conclusion, the main indication for insulin pump therapy in adults is the frequency of hypoglycemia, especially nocturnal ones. Cilj studije bio je istražiti koji su odrasli bolesnici s tipom 1 dijabetesa liječeni s više dnevnih doza inzulina najbolji kandidati za liječenje inzulinskom crpkom, uzimajući u obzir njihovu ograničenu dostupnost u Republici Hrvatskoj. Na Zavodu za endokrinologiju Interne klinike Kliničkoga bolničkog centra Zagreb praćeno je 145 bolesnika s tipom 1 dijabetesa (kod 52% njih je bolest dijagnosticirana u odrasloj dobi) u razdoblju od 2009. do 2014. godine. Kod 21 bolesnika (7 muškaraca i 14 žena, medijan dobi 27 godina) liječenje crpkom započelo je u odrasloj dobi. Petoro bolesnika je imalo kronične komplikacije (dvoje retinopatiju, jedan polineuropatiju, a dvoje je imalo i retinopatiju i neuropatiju). Medijan HbA1c prije započinjanja liječenja inzulinskom crpkom je bio 6,95%, a nakon godine dana terapije crpkom 6,5%. Bolesnici su bili razvrstani prema indikaciji za liječenje crpkom (učestale i/ili teške hipoglikemije, specifičan stil života, nepostizanje željenih ciljeva glikemije unatoč suradljivosti/nestabilan dijabetes te pretkoncepcija). Bolesnici su mogli ispunjavati i više od jedne indikacije. Na početku liječenja učestalost hipoglikemija se analizirala kontinuiranim praćenjem glukoze tijekom 5-6 dana, a reevaluacija je učinjena iz anamnestičkih podataka nakon 1 godine ± 3 mjeseca. Na samom početku liječenja bolesnici su imali 5 hipoglikemija/6 dana (30% noćnih), a nakon godine dana 1 hipoglikemiju/6 dana (bez noćnih). Wilcoxonov signed-rank test pokazao je statistički značajnu razliku u broju i učestalosti noćnih hipoglikemija te u HbA1c. Kod onih bolesnika u kojih je liječenje započelo inzulinskom crpkom s indikacijom hipoglikemije prije crpke medijan HbA1c je bio 6,7% sa 7 hipoglikemija/6 dana (50% noćnih). Nakon godinu dana medijan HbA1c je bio 6% s 1 hipoglikemijom /6 dana (bez noćnih). Kao zaključak, vodeća indikacija za liječenje inzulinskom crpkom u odraslih bolesnika je učestalost hipoglikemija, osobito noćnih. |
| Databáze: | OpenAIRE |
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