| Objective: Insulin treatment is very difficult in infants with Type 1 Diabetes Mellitus(T1DM).There are only some research data in foreign countries,and there is a lack of relevant data in China.This study summarized the clinical efficacy and preliminary experience of Continuous Subcutaneous Insulin Infusion(CSII)in the treatment of infants with T1 DM in our hospital.Methods: From June 2016 to May 2020,16 cases of T1 DM children under 3 years old diagnosed in the Department of Endocrinology and Metabolism of Qingdao Women’s and Children’s Hospital were selected as the research subjects.Parents chose the insulin application method independently.Eight children chose CSII treatment and the other eight chose Multiple Daily Insulin Injection(MDI)treatment.Clinical data of two groups of children were collected to evaluate Hemoglobin A1 c at admission,6 months of treatment,and 1 year of treatment.Hb A1 c level,C-peptide,insulin level,insulin dosage,Mean Amplitude of Glycemic Excursions(MAGE),hypoglycemia and Diabetic Ketoacidosis(DKA).Questionnaire was conducted to investigate the family satisfaction and the reasons for having pumps in the CSII group.Results:(1)Basic information: A total of 16 children were included,including 11 females and 5 males,aged(3.76±1.01)years old,average age of onset(1.75±0.66)years old(minimum age with pump was 7 days in October),average course of disease(2.14±0.91)years old,average duration of carrying pump(1.80±0.63)years old.There were no significant differences in the onset age,gender,blood glucose and Hb A1 c levels between the two groups.(2)Hb A1 c level: Compared with the MDI group,the CSII group at 6 months[(6.18±0.86)% vs.(7.09±0.37)%;t=-2.779,P=0.015] and at 1 year [(6.50±0.49)% vs.(7.04±0.33)%;t=-2.608,P=0.021] The difference between the two groups was statistically significant.After 6 months of treatment,Hb A1 c decreased in both groups,and the decrease rate of Hb A1 c in CSII group [(5.77±2.92)%] was significantly higher than that in MDI group [(3.13±1.72)%](t=2.200,P=0.045).(3)C-peptide and insulin levels:There was no significant difference in C-peptide levels between the two groups.After 6 months of treatment,the insulin level of the CSII group [(21.73±8.00)u IU/ml] was significantly higher than that of the MDI group[(11.69±6.80)u IU /ml],and the difference was statistically significant(t=2.704,P=0.017).There was no statistically significant difference in the insulin level between the two groups after 1 year of treatment.(4)Dosage of insulin: In the CSII group,compared with the MDI group,at 6months [(0.72±0.09)IU/kg vs(0.86±0.07)IU/kg;t=-3.451,P=0.004] and 1 year of treatment [(0.66±0.11)IU/kg vs(0.90±0.14)IU/kg;t=-3.795,P=0.002].(5)MAGE level: CSII group compared with MDI group,at 6 months of treatment[(4.46±0.44)mmol/L vs(9.08±0.39)mmol/L;t=-22.445,P=0.000] and 1 year of treatment[(4.33±0.68)mmol/L vs(7.67±0.60)mmol/L;t=-10.349,P=0.000] was statistically significant.(6)Ketoacidosis and hypoglycemia events: None of the 16 children had severe hypoglycemia after treatment,except 1 case in the CSII group and 2 cases in the MDI group.Ketoacidosis occurred in 8 patients(50%),and only 1 child treated with MDI developed a recurrence of ketoacidosis after treatment.(7)Reasons,adverse reactions,and satisfaction survey: 3 cases(37.5%)had more free diet,3 cases(37.5%)had less injections,and 2 cases(25%)had more stable blood glucose control.During the course of treatment,1 patient(12.5%)had rejected this method,but still chose to continue treatment.During CSII treatment,7 cases(87.5%)developed skin complications.The majority of parents(62.5%)were satisfied with CSII treatment.(8)Safety of ordinary insulin as pump therapy drug: Among the 8 children treated with CSII,5 cases were treated with ordinary insulin as pump therapy,and the clinical effect was good without tube blockage.Conclusion:The application of CSII in the treatment of infants with T1 DM is relatively safe,with good overall blood glucose control,significantly improved Hb A1 c,reduced insulin dosage,decreased hypoglycemia and ketoacidosis events,decreased adverse reactions,and higher satisfaction of parents.Common insulin as pump therapy is suitable for infants with T1 DM. |
