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Læknablaðið - 15.05.2011, Blaðsíða 15

Læknablaðið - 15.05.2011, Blaðsíða 15
RANNSÓKN Heimildir 1. Pickup JC, Keen H, Parsons JA, Aolberti KGMM, Rowe AS. Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. BMJ 1978; 1: 204- 7. 2. Mecklenburg RS, Benson JW, Becker NM, et al. Clinical use of the insulin infusion pump in 100 patients with type 1 diabetes. N Engl J Med 1982; 307: 513-8. 3. Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy: a meta-analysis. Diabetes Care 2003; 26:1079-87. 4. Giménez M, Conget I, Jansá M, Vidal M, Chiganer G, Levy I. Efficiacy of cotinuous subcutaneous insulin infusion in Type 1 diabetes: a 2-year perspective using the established criteria for funding from a National Health Service. Diabet Med 2007; 24:1419-142. 5. Linkeschova R, Raoul M, Bott U, Berger M, Spraul M. Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med 2002; 19: 746- 51. 6. The equalityl study group. Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continous subcutaneous insulin infusion and multiple daily injections. Diabet Med 2008; 25:213-20. 7. Graff MR, Rubin RR, Walker EA: How diabetes specialists treat their own diabetes: findings from a study of the AADE and ADA membership. Diabetes Educ 2000; 26: 460-67. 8. The DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-86. 9. Chase HP, Saib SZ, MacKenzie T, Hansaen MM, Garg SK. Post-prandial glucose excursions following four methods of bolus insulin administration in subjects with type 1 diabetes. Diabet med 2002; 19:317-21. 10. NICE technology appraisal guidance 151, continous subcutaneous insulin infusion for the treatment og diabetes mellitus. quidance.nice.org.uk/TA151 apríl 2011. 11. Roze S, Valentine WJ, Zakrezwska KE, Palmer AJ. Health- economic comparison of continuous subcutaneous insulin infusion with multiple daily injection for the treatment of type 1 diabetes in the UK. Diabet Med 2004; 22; 1239-45. 12. Pickup J, Matock M, Kerry S. Glycaemic control with continous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ 2002; 324:1-6. 13. Retnakaran R, Hochman J, DeVries JH, et al. Continous subcutaneous insulin infusion versus multiple daily injections. Diabetes care 2004; 27: 2590-6. 14. Rodrigues IAS, Reid HA, Ismail K, Amiel SA. Indication and efficiacy of continous subcutaneous insulin infusion (CSII) thearpy in type 1 diabetes mellitus: a clinical audit in a specialist service. Diabet Med 2005; 22: 842-9. 15. Þórsson B, Aspelund T, Harris TB, Launer LJ, Guðnason V. Þróun holdafars og sykursýki í 40 ár á íslandi. Læknablaðið 2009; 95: 259-66. 16. Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med 2008; 25: 765-74. ENGLISH SUMMARY Treatment of type 1 diabetes with continuous subcutaneous insulin infusion (CSII) in adults in lceland Bodvarsdottir KO, Aspelund T, Gudmundsdottir A Objective: The goal of the study was to evaluate the effect and safety of CSII treatment in individuals 18 years and older with type 1 diabetes mellitus in lceland. Methods: The research is retrospective. We gathered information from patient data of 40 individuals, age 19-57 years who had been treated with CSII in lceland for 6 months or longer during the period January 2004 until December 2007 . We looked at the effect of the treatment on treatment complications, HbA1c, body mass index (BMI) and insulin requirements compared with multiple daily injections (MDI). Results: HbA1c was lower on CSII but the difference was not significant. Mean initial HbA1c was 7.23 (95% confidence limits 6.29-8.18) for men and 6.93 (95% confidence limits 6.57-7.28) for women. The change in BMI was not significant. Mean initial BMI for men was 25.5 (95% confidence limits 23.6-27.3) and 25.9 (95% confidence limits 23.8-27.9) for women. Insulin requirements were significantly lower at the end of the study for both men and women. Insulin requirements decreased by mean 11.3 units for men (P=0.04) and 12.8 units for women (P=0.0009). There where six episodes of ketoacidosis, four of skin infections and two hypoglycemias that needed doctors attention while using CSII treatment. Conclusion: The experience of CSII treatment in lceland is good. These results confirm that this treatment is safe and as effective as other treatment forms. Even tough the difference in HbA1c was not significant the result showed that those who had the highest HbA1c at the beginning of CSII treatment did get the best result with the pump and the insulin dosage was lower with CSII than with MDI. Key words: Diabetes, Continuous subcutaneous insulin infusion, HbA1c, Insulin dose, hypoglycemia Correspondence: Arna Guðmundsdóttir, arnagu@landspitali.is LÆKNAblaðið 2011/97 295
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