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Improved metabolic control with less insulin in type 1 diabetic patients treated with the continuous subcutaneous insulin infusion (CSII) system
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OBJECTIVOS Investigar as alterações nos valores de hemoglobina glicada e na dose basal de insulina em doentes diabéticos tipo 1 com muito mau controlo metabólico que alteraram o esquema terapêutico de múltiplas injeções diárias de insulina para as bombas de infusão contínua de insulina.
PACIENTES E MÉTODOS Para este estudo utilizámos a base de dados DMHSM.DBF, juntamente com o Statistical Package for the Social Sciences Program (IBM SPSS inc., Chicago, 20th version), que inclui todos os dados médicos relevantes dos pacientes atendidos por um único médico no departamento de Endócrino. Este estudo focasse nas alterações dos valores de hemoglobina glicada e nas doses basais de insulina, em 24 adultos com diabetes tipo 1 e uma HbA1c elevada (≥7,5%) que cumpriam o esquema terapêutico de múltiplas injeções diárias de insulina e alteraram-no para as bombas de infusão contínua de insulina, durante um período de quatro anos.
RESULTADOS Em todos os casos identificamos um decréscimo da hemoglobina glicada depois do inicio do esquema terapêutico com as bombas de infusão continua de insulina, alcançando significância somente aos 24 meses diminuindo de 10.2±3.4% para 9.6±1.5% (P < 0.05), com diferenças médias absolutas que variavam de 0,5% a 2,0%. Durante os 4 anos de terapia a dose basal de insulina decresceu de 44.7± 5.4 U/dia com a terapêutica das múltiplas injeções diárias para 29.7±9.6 U/dia com as bombas de infusão contínua de insulina, com diferenças médias absolutas entre os 13-19 U/dia.
DISCUSSÃO Este estudo retrospectivo mostra-nos que existe uma melhoria sustentada no controlo metabólico e uma redução na dose basal de insulina nos doentes diabéticos tipo 1, anteriormente mal controlados e a realizar esquema de múltiplas injecções diárias de insulina, depois de iniciarem as bombas de infusão contínua de insulina. Podemos concluir que no nosso específico grupo de doentes o esquema terapêutico com bombas de infusão contínua de insulina foi o único que se mostrou efetivo em conseguir manter um controlo metabólico restrito.
AIMS To investigate the patterns of changes in the HbA1c and insulin basal doses requirements in patients with poorly controlled Type 1 diabetes that were switched to continuous subcutaneous insulin infusion after attempts to improve control with multiple daily injection. PATIENTS AND METHODS For this paper we used the CSII system, the Statistical Package for the Social Sciences Program (IBM SPSS inc., Chicago, 20th version) and the DMHSM.DBF database, which includes the data for all patients assisted by a single doctor at the endocrine department. The study focuses on HbA1c and daily insulin requirement changes, in 24 adult patients with Type 1 Diabetes and an elevated HbA1c (≥7,5%) on multiple daily insulin injections, who where then switched to continuous subcutaneous insulin infusion for at least 4 years. RESULTS In all cases, we identified a decrease in glycosylated haemoglobin after beginning CSII therapy, reaching significance only at 24 months, decreased from 10.2±3.4% to 9.6±1.5% (P < 0.05), with absolute mean differences between 0,5% and 2,0%. During the 4 years of therapy daily insulin requirements decreased from 44.7± 5.4 U/day with MDI therapy to 29.7±9.6 U/day (P < 0.04) with CSII, with absolute mean differences between 13-19 U/day. DISCUSSION Retrospectively, this study shows that CSII provided a sustained improvement in glycaemic control and decreased insulin baseline requirements in Type 1 diabetic patients that were poorly controlled with previous MDI treatments. We can conclude that on our specific group of patients, the CSII therapy was the only effective treatment in maintaining a strict metabolic control.
AIMS To investigate the patterns of changes in the HbA1c and insulin basal doses requirements in patients with poorly controlled Type 1 diabetes that were switched to continuous subcutaneous insulin infusion after attempts to improve control with multiple daily injection. PATIENTS AND METHODS For this paper we used the CSII system, the Statistical Package for the Social Sciences Program (IBM SPSS inc., Chicago, 20th version) and the DMHSM.DBF database, which includes the data for all patients assisted by a single doctor at the endocrine department. The study focuses on HbA1c and daily insulin requirement changes, in 24 adult patients with Type 1 Diabetes and an elevated HbA1c (≥7,5%) on multiple daily insulin injections, who where then switched to continuous subcutaneous insulin infusion for at least 4 years. RESULTS In all cases, we identified a decrease in glycosylated haemoglobin after beginning CSII therapy, reaching significance only at 24 months, decreased from 10.2±3.4% to 9.6±1.5% (P < 0.05), with absolute mean differences between 0,5% and 2,0%. During the 4 years of therapy daily insulin requirements decreased from 44.7± 5.4 U/day with MDI therapy to 29.7±9.6 U/day (P < 0.04) with CSII, with absolute mean differences between 13-19 U/day. DISCUSSION Retrospectively, this study shows that CSII provided a sustained improvement in glycaemic control and decreased insulin baseline requirements in Type 1 diabetic patients that were poorly controlled with previous MDI treatments. We can conclude that on our specific group of patients, the CSII therapy was the only effective treatment in maintaining a strict metabolic control.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Diabetes mellitus tipo 1 Insulina Sistemas de infusão de insulina