The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778 |
Resumo: | Introduction: The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra.Material and Methods: This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra. Glycated hemoglobin A1c, body mass index, total daily dose of insulin and acute complications associated with continuous subcutaneous insulin infusion therapy were evaluated immediately prior to initiation of continuous subcutaneous insulin infusion therapy with follow-up at six months, one year, five, 10, 15 and 20 years. The frequency of acute complications associated with this type of therapy was also evaluated.Results: This study included 20 patients (seven males, 13 females) with mean disease duration up to the start of continuous subcutaneous insulin infusion therapy of 16.1 ± 7.9 years, mean age of onset of continuous subcutaneous insulin infusion therapy of 31.1 ± 8.4 years and follow-up during 13.2 ± 2.3 years. The reasons for initiating pump therapy were: inadequate metabolic control in 15 patients, history of asymptomatic or severe hypoglycemia in four patients, and pregnancy/pregnancy planning in one patient. The previous median of glycated hemoglobin A1c was 9.3% (6.5 – 16.0) and, at six months, decreased to the minimum value of 7.2% (5.3 – 9.8); p < 0.0125. The reduction of glycated hemoglobin A1c remained statistically significant in the first 10 years of follow-up. There was a statistically significant difference in the body mass index variation at 10 years with continuous subcutaneous insulin infusion therapy compared to previous body mass index; 24.7 kg/m2 (18.9 – 31.8) vs 25,5 kg/m2 (18.9 – 38.9), p < 0.0125. Daily insulin requirements were reduced from 56.5 U (32.0 – 94.0) to 43.8 U (33.0 – 64.0) (p < 0.0125) at six months and no statistical differences were found in the remaining follow-up. There were two severe episodes of hypoglycemia (incidence 0.0095/patient/year), five episodes of diabetic ketoacidosis (0.0238/patient/year) and no infections at the site of catheter insertion.Discussion: This study shows that continuous subcutaneous insulin infusion therapy improved glycemic control, especially during the first 10 years of follow-up and allowed a significant decrease in total daily dose of insulin in the first six months. The rate of acute complications was low.Conclusion: Treatment with continuous subcutaneous insulin infusion therapy seems effective in achieving metabolic control in selected patients with type 1 diabetes mellitus. |
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The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 DiabetesImpacto do Uso Prolongado da Terapêutica Subcutânea Contínua com Insulina no Controlo da Diabetes Mellitus Tipo 1Diabetes MellitusType 1Glycated Hemoglobin AInfusionsSubcutaneousInsulin Infusion SystemsInsulinDiabetes Mellitus Tipo 1Hemoglobina Glicada A1cInfusões SubcutâneasInsulinaSistemas de Perfusão de InsulinaIntroduction: The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra.Material and Methods: This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra. Glycated hemoglobin A1c, body mass index, total daily dose of insulin and acute complications associated with continuous subcutaneous insulin infusion therapy were evaluated immediately prior to initiation of continuous subcutaneous insulin infusion therapy with follow-up at six months, one year, five, 10, 15 and 20 years. The frequency of acute complications associated with this type of therapy was also evaluated.Results: This study included 20 patients (seven males, 13 females) with mean disease duration up to the start of continuous subcutaneous insulin infusion therapy of 16.1 ± 7.9 years, mean age of onset of continuous subcutaneous insulin infusion therapy of 31.1 ± 8.4 years and follow-up during 13.2 ± 2.3 years. The reasons for initiating pump therapy were: inadequate metabolic control in 15 patients, history of asymptomatic or severe hypoglycemia in four patients, and pregnancy/pregnancy planning in one patient. The previous median of glycated hemoglobin A1c was 9.3% (6.5 – 16.0) and, at six months, decreased to the minimum value of 7.2% (5.3 – 9.8); p < 0.0125. The reduction of glycated hemoglobin A1c remained statistically significant in the first 10 years of follow-up. There was a statistically significant difference in the body mass index variation at 10 years with continuous subcutaneous insulin infusion therapy compared to previous body mass index; 24.7 kg/m2 (18.9 – 31.8) vs 25,5 kg/m2 (18.9 – 38.9), p < 0.0125. Daily insulin requirements were reduced from 56.5 U (32.0 – 94.0) to 43.8 U (33.0 – 64.0) (p < 0.0125) at six months and no statistical differences were found in the remaining follow-up. There were two severe episodes of hypoglycemia (incidence 0.0095/patient/year), five episodes of diabetic ketoacidosis (0.0238/patient/year) and no infections at the site of catheter insertion.Discussion: This study shows that continuous subcutaneous insulin infusion therapy improved glycemic control, especially during the first 10 years of follow-up and allowed a significant decrease in total daily dose of insulin in the first six months. The rate of acute complications was low.Conclusion: Treatment with continuous subcutaneous insulin infusion therapy seems effective in achieving metabolic control in selected patients with type 1 diabetes mellitus.Introdução: O uso da terapêutica com perfusão subcutânea contínua de insulina na diabetes mellitus tipo 1 é cada vez mais frequente devido aos seus efeitos benéficos no controlo glicémico e na flexibilidade do estilo de vida. Constituiu objetivo deste estudo avaliar o impacto da terapêutica com perfusão subcutânea contínua de insulina no controlo glicémico, índice de massa corporal, dose diária total de insulina e complicações desta modalidade terapêutica durante vinte anos de experiência no Centro Hospitalar e Universitário de Coimbra.Material e Métodos: Estudo retrospetivo que inclui doentes com diabetes mellitus tipo 1 seguidos no Centro Hospitalar e Universitário de Coimbra, que iniciaram terapêutica com perfusão subcutânea contínua de insulina até 2005 e com pelo menos 10 anos de tratamento com terapêutica com perfusão subcutânea contínua de insulina. Avaliou-se a hemoglobina glicada A1c, o índice de massa corporal e a dose diária total de insulina imediatamente antes e seis meses, um ano, cinco, 10, 15 e 20 anos após terapêutica com perfusão subcutânea contínua de insulina a partir dos registos médicos. Avaliou-se ainda a frequência de complicações agudas associadas a este tipo de terapêutica.Resultados: Obtiveram-se dados de 20 doentes (sete homens; 13 mulheres) com duração média de doença até início da terapêutica com perfusão subcutânea contínua de insulina de 16,1 ± 7,9 anos, idade média de início de terapêutica com perfusão subcutânea contínua de insulina de 31,1 ± 8,4 anos e seguimento durante 13,2 ± 2,3 anos. As indicações para colocação de bomba foram: inadequado controlo metabólico em 15 doentes, história de hipoglicemias assintomáticas ou severas em quatro doentes, e gravidez/planeamento de gravidez em um doente. A mediana de hemoglobina glicada A1c prévia foi 9,3% (6,5 - 16,0) tendo diminuído aos seis meses para o valor mínimo de 7,2% (5,3 - 9,8); p < 0,0125. A redução da hemoglobina glicada A1c manteve-se estatisticamente significativa nos primeiros 10 anos de seguimento. Verificou-se uma diferença estatisticamente significativa na variação do índice de massa corporal após 10 anos de seguimento comparativamente com o valor prévio à terapêutica com perfusão subcutânea contínua de insulina; 24,7kg/m2 (18,9 - 31,8) vs 25,5 kg/m2 (18,9 - 38,9), p < 0,0125. As necessidades diárias de insulina foram reduzidas de 56,5 U (32,0 - 94,0) para 43,8 U (33,0 - 64,0) (p < 0,0125) nos primeiros seis meses e não se encontraram diferenças estatísticas no restante seguimento relativamente às necessidades prévias à terapêutica com perfusão subcutânea contínua de insulina. Verificaram-se duas hipoglicemias severas (incidência 0,0095/doente/ano), cinco cetoacidoses diabéticas (0,0238/doente/ano) e nenhuma infeção no local de inserção do cateter.Discussão: Este estudo demonstrou a eficácia da terapêutica com perfusão subcutânea contínua de insulina, que está associada a uma diminuição significativa da hemoglobina glicada A1c sustentada durante 10 anos e a uma redução da dose diária total de insulina, significativa nos primeiros seis meses. A taxa de complicações agudas foi baixa.Conclusão: A evidência sugere que a terapêutica com perfusão subcutânea contínua de insulina é efetivamente vantajosa no controlo metabólico em doentes com diabetes mellitus tipo 1 selecionados. Ordem dos Médicos2019-02-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfimage/x-ms-bmpimage/x-ms-bmpimage/x-ms-bmpimage/x-ms-bmpapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/pdfimage/x-ms-bmpapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778oai:ojs.www.actamedicaportuguesa.com:article/10778Acta Médica Portuguesa; Vol. 32 No. 1 (2019): January; 17-24Acta Médica Portuguesa; Vol. 32 N.º 1 (2019): Janeiro; 17-241646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/5588https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/6070https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10363https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10364https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10621https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10622https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10623https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10624https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10625https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10923https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/11076https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/11077Direitos de Autor (c) 2019 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessAzevedo, SérgioSaraiva, JoanaCaramelo, FranciscoFadiga, LúciaBarros, LuísaBaptista, CarlaMelo, MiguelGomes, LeonorCarrilho, Francisco2022-12-20T11:06:05Zoai:ojs.www.actamedicaportuguesa.com:article/10778Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:56.798091Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes Impacto do Uso Prolongado da Terapêutica Subcutânea Contínua com Insulina no Controlo da Diabetes Mellitus Tipo 1 |
title |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
spellingShingle |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes Azevedo, Sérgio Diabetes Mellitus Type 1 Glycated Hemoglobin A Infusions Subcutaneous Insulin Infusion Systems Insulin Diabetes Mellitus Tipo 1 Hemoglobina Glicada A1c Infusões Subcutâneas Insulina Sistemas de Perfusão de Insulina |
title_short |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
title_full |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
title_fullStr |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
title_full_unstemmed |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
title_sort |
The Impact of Prolonged Use of Continuous Subcutaneous Insulin Infusion in the Control of Type-1 Diabetes |
author |
Azevedo, Sérgio |
author_facet |
Azevedo, Sérgio Saraiva, Joana Caramelo, Francisco Fadiga, Lúcia Barros, Luísa Baptista, Carla Melo, Miguel Gomes, Leonor Carrilho, Francisco |
author_role |
author |
author2 |
Saraiva, Joana Caramelo, Francisco Fadiga, Lúcia Barros, Luísa Baptista, Carla Melo, Miguel Gomes, Leonor Carrilho, Francisco |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Azevedo, Sérgio Saraiva, Joana Caramelo, Francisco Fadiga, Lúcia Barros, Luísa Baptista, Carla Melo, Miguel Gomes, Leonor Carrilho, Francisco |
dc.subject.por.fl_str_mv |
Diabetes Mellitus Type 1 Glycated Hemoglobin A Infusions Subcutaneous Insulin Infusion Systems Insulin Diabetes Mellitus Tipo 1 Hemoglobina Glicada A1c Infusões Subcutâneas Insulina Sistemas de Perfusão de Insulina |
topic |
Diabetes Mellitus Type 1 Glycated Hemoglobin A Infusions Subcutaneous Insulin Infusion Systems Insulin Diabetes Mellitus Tipo 1 Hemoglobina Glicada A1c Infusões Subcutâneas Insulina Sistemas de Perfusão de Insulina |
description |
Introduction: The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra.Material and Methods: This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra. Glycated hemoglobin A1c, body mass index, total daily dose of insulin and acute complications associated with continuous subcutaneous insulin infusion therapy were evaluated immediately prior to initiation of continuous subcutaneous insulin infusion therapy with follow-up at six months, one year, five, 10, 15 and 20 years. The frequency of acute complications associated with this type of therapy was also evaluated.Results: This study included 20 patients (seven males, 13 females) with mean disease duration up to the start of continuous subcutaneous insulin infusion therapy of 16.1 ± 7.9 years, mean age of onset of continuous subcutaneous insulin infusion therapy of 31.1 ± 8.4 years and follow-up during 13.2 ± 2.3 years. The reasons for initiating pump therapy were: inadequate metabolic control in 15 patients, history of asymptomatic or severe hypoglycemia in four patients, and pregnancy/pregnancy planning in one patient. The previous median of glycated hemoglobin A1c was 9.3% (6.5 – 16.0) and, at six months, decreased to the minimum value of 7.2% (5.3 – 9.8); p < 0.0125. The reduction of glycated hemoglobin A1c remained statistically significant in the first 10 years of follow-up. There was a statistically significant difference in the body mass index variation at 10 years with continuous subcutaneous insulin infusion therapy compared to previous body mass index; 24.7 kg/m2 (18.9 – 31.8) vs 25,5 kg/m2 (18.9 – 38.9), p < 0.0125. Daily insulin requirements were reduced from 56.5 U (32.0 – 94.0) to 43.8 U (33.0 – 64.0) (p < 0.0125) at six months and no statistical differences were found in the remaining follow-up. There were two severe episodes of hypoglycemia (incidence 0.0095/patient/year), five episodes of diabetic ketoacidosis (0.0238/patient/year) and no infections at the site of catheter insertion.Discussion: This study shows that continuous subcutaneous insulin infusion therapy improved glycemic control, especially during the first 10 years of follow-up and allowed a significant decrease in total daily dose of insulin in the first six months. The rate of acute complications was low.Conclusion: Treatment with continuous subcutaneous insulin infusion therapy seems effective in achieving metabolic control in selected patients with type 1 diabetes mellitus. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-02-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778 oai:ojs.www.actamedicaportuguesa.com:article/10778 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/10778 |
dc.language.iso.fl_str_mv |
por eng |
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por eng |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/5588 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/6070 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10363 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10364 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10621 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10622 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10623 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10624 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10625 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/10923 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/11076 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10778/11077 |
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Direitos de Autor (c) 2019 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2019 Acta Médica Portuguesa |
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openAccess |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 32 No. 1 (2019): January; 17-24 Acta Médica Portuguesa; Vol. 32 N.º 1 (2019): Janeiro; 17-24 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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