PDF(Pubmed)
Abstract：
We previously published that insulin pump initiation immediately after IV insulin therapy was associated with improved post-surgical glycemic outcomes compared to multiple daily injections (MDI) in pediatric patients following a total pancreatectomy with islet autotransplantation (TPIAT). We investigated metabolic outcomes of this population at one-year post-TPIAT to assess if the improved outcomes in the early pump group were sustained over time. We retrospectively reviewed 40 patients post-TPIAT previously studied at 10-days post-surgery (15 used MDI and 25 used pump therapy immediately post-ICU, and all were discharged on pump therapy). Data analyzed included: demographics, islet equivalents per kilogram (IEQ/kg) transplanted, exogenous insulin use, and baseline vs. one-year (via mixed meal testing) HbA1c, fasting glucose, insulinogenic index, and the area under the curve (AUC) for insulin and c-peptide. More patients were off insulin at one year in the early pump group compared to the MDI group (45% vs. 13%, p = 0.07). Of all patients off insulin, 100% of the early pump users weaned off by six months post-TPIAT compared to 30% of the MDI users. Two known variables associated with favorable insulin outcomes, lower age and higher IEQ/kg, were not significantly different between groups. Fasting glucose was lower in the early pump group compared to the MDI group (median 97 vs. 122 mg/dL, p = 0.003), while AUC c-peptide was greater in early pump users at one-year post-TPIAT but did not reach significance (median 57.0 vs. 50.3 ng/mL × minutes, p = 0.14). Other metabolic outcomes did not differ between groups. Despite lower median age and higher IEQ/kg in the MDI group, the early pump group had a lower fasting glucose. Younger TPIAT age (p = 0.02) and early pump users (p = 0.04) were significantly associated with insulin independence at one year. This study was limited by sample size. Early pump use may have long-term benefits in post-TPIAT endogenous insulin secretion.
摘要：
我们以前曾发表过，在全胰腺切除术伴胰岛自体移植（TPIAT）后，与每日多次注射（MDI）相比，静脉胰岛素治疗后立即启动胰岛素泵与改善术后血糖结果相关。我们调查了该人群在TPIAT后一年的代谢结果，以评估早期泵组的改善结果是否随时间持续。我们回顾性回顾了40例TPIAT术后患者在手术后10天进行的研究（15例使用的MDI和25例ICU后立即使用的泵治疗，所有患者均接受泵治疗）。分析的数据包括：人口统计，每公斤胰岛当量（IEQ/kg）移植，外源性胰岛素的使用，和基线与一年（通过混合膳食测试）HbA1c，空腹血糖,促胰岛素指数，以及胰岛素和c肽的曲线下面积(AUC)。与MDI组相比，早期泵组一年内有更多的患者停用胰岛素(45%vs.13%,p=0.07)。在所有停用胰岛素的患者中，100％的早期泵用户在TPIAT后六个月断奶，而MDI用户为30％。与有利的胰岛素结果相关的两个已知变量，较低的年龄和较高的IEQ/kg，组间无显著差异。与MDI组相比，早期泵组的空腹血糖较低（中位数97vs.122mg/dL,p=0.003),而在TPIAT后一年，早期泵使用者的AUCc肽更高，但未达到显着性（中位数57.0vs.50.3ng/mL×分钟，p=0.14）。其他代谢结果在组间没有差异。尽管MDI组的中位年龄较低，IEQ/kg较高，早期泵组的空腹血糖较低。年轻的TPIAT年龄（p=0.02）和早期的泵使用者（p=0.04）与一年的胰岛素独立性显着相关。本研究受样本量的限制。早期使用泵可能对TPIAT后内源性胰岛素分泌具有长期益处。
