Treatment Efficacy of Subcutaneous Insulin Infusion Therapy In Type 1 Diabetic Patients - Orijinal Article

摘要

?zet Ama?: Diyabet tedavisinde güncel hedefler, normale yak?n glisemiyi sa?lamak, ?iddetli hipoglisemi riskini en aza indirmek, kilo al?m?n? s?n?rlamak ve ya?am kalitesini iyile?tirmektir. Sürekli cilt alt? insülin infüzyonu (SC??) tedavisi, tüm bu hedeflere ula?may? ama?layan bir tedavi se?ene?i sa?lamaktad?r. SC??, yo?un insülin enjeksiyonu (Y?E) tedavisi alan motive ve yetenekli diyabet hastalar? i?in tedavide uygun bir alternatif olu?turmaktad?r. Biz bu ?al??mam?zda SC?? ve Y?E kullanan hastalar?m?zda diyabetik kontrol ve tedavi memnuniyetini kar??la?t?rmay? ama?lad?k. Gere? ve Y?ntemler: 2005-2008 y?llar?nda takip edilen 50 tip 1 diyabet hastas? ?al??maya dahil edildi. SC?? ?ncesi, son bir y?l ve ?al??ma sonunda biyokimyasal sonu?lardaki de?i?iklikler (glikozillenmi? hemoglobin; HbA1c), hipoglisemi ve kilo art??? retrospektif olarak analiz edildi. Tedavi uyumu ve memnuniyetinin ara?t?rmak i?in 12 adet soru i?eren bir anket kullan?ld?. Hastalar Y?E kullanan ve en az bir y?ldan beri SC?? kullanan hastalar olmak üzere iki gruba al?nd?. (Grup 1; n:27; SC?? kullanan hastalar, Grup 2; n:23; Y?E kullanan hastalar) Bulgular: Her iki grupta son HbA1c düzeylerine bak?ld???nda anlaml? fark tespit edilmedi. SC?? grubunda tedaviye ge?meden ?nceki HbA1c de?erlerinde ortalama 1,66 y?ll?k takip süresinde %0,79 ortalama dü?ü? mevcuttu (%9,19±2,23; %8,40±1,17). Her iki grup kar??la?t?r?ld???nda hipoglisemi oranlar? ve son bir y?lda kilo art??? a??s?ndan istatistiksel olarak anlaml? fark saptanmad?, ancak SC?? grubunda hipoglisemi oranlar? daha dü?üktü. Son olarak SC?? grubundaki hastalarda evde kan ?eker ?l?ümü s?kl???n?n daha yüksek olmas? ile birlikte daha yüksek uyum ve daha yüksek tedavi memnuniyeti oran? tespit edildi, ayr?ca tüm hastalar incelendi?inde evde kan ?eker ?l?ümü s?kl??? ile HbA1c de?erleri aras?nda negatif korelasyon saptand?. Sonu?: SC?? tedavisi se?ilmi? tip 1 diyabetik hastalarda ?oklu enjeksiyon tedavisi ile kar??la?t?r?ld???nda, daha yüksek tedavi memnuniyeti ile beraber, glisemik kontrolü iyile?tirmede etkilidir. Türk Jem 2010; 14: 80-4 Anahtar kelimeler: Sürekli cilt alt? insülin infüzyonu (SC??), yo?un insülin enjeksiyonu (Y?E), glisemik kontrol, tedavi memnuniyeti, tedavi uyumu Abstract Objective: Current goals of treatment of diabetes are to achieve near-normal glycemia, minimize the risk of severe hypoglycemia, limit excessive weight gain, and to improve quality of life. Insulin pump or continuous subcutaneous insulin infusion (CSII) therapy provides a treatment option to aid in achieving all of these goals. CSII is a viable alternative to multiple daily injections (MDI) therapy for patients with diabetes who are capable and motivated. In this study, we aimed to compare the diabetic control and treatment satisfaction in our patients using CSII and MDI. Materials and Methods: Fifty patients with type 1 diabetes, who had been followed between 2005-2008, were enrolled in the study. Changes in biomedical outcomes (glycated haemoglobin; HbA1c), hypoglycaemia, and weigth gain pre-CSII, during the last year and at the end of the study were analyzed retrospectively. For treatment satisfaction and compliance, we used a questionnaire containing 12 questions. The patients were divided into two groups according to MDI or CSII therapy use for least one year: Group 1 using CSII (n:27) and Group 2 using MDI (n:23). Results: There was no significant difference between the last HbA1c levels in both groups. In CSII group, decrease in HbA1c was 0.79% for average follow-up of 1.66 years ( 9.19%±2.23; 8.40%±1.17). When the two groups were compared in terms of hypoglycemia rates and weight gain over the last year, no statistically significant difference was found, but in CSII group, hypoglycemia rates were lower. Finally, CSII group demonstrated a higher treatment satisfaction rate and higher compliance, while a negative correlation was detected between frequency of home blood glucose monitoring and HbA1c levels in all patients. Conclusion: CSII therapy is effective in improving glycemic control with higher treatment satisfaction when compared with MDI therapy in selected type 1 diabetic patients. Turk Jem 2010; 14: 80-4