THE TERAPIJA INSULINSKOM PUMPOM U TIPU 1 DIJABETESA: ZNAČAJ VARIJABILNOSTI GLIKEMIJE
Sažetak
Uvod: Terapijski režim kontinuirane supkutane insulinske infuzije se pokazao kao efikasniji u odnosu na multiple dnevne injekcione doze insulinom. Iako je doveo HbA1c u optimalne granice, jedan od glavnih izazova ovog terapijskog režima i dalje ostaje neadekvatna fluktuacija glikemija, tj. neregulisana glukozna varijabilnost.
Cilj: Cilj ovog istraživanja bio je da ispita kontrolu glukozne varijabilnosti kod pacijenata prevedenih sa MDII na CSII terapijski režim.
Materijal i metode: Ovom studijom je vršena retrogradna analiza podataka iz postojeće elektronske baze i kartona 65 pacijenata koji se leče na Klinici za endokrinologiju, dijabetes i bolesti metabolizma Kliničkog centra Srbije. Analizirani su podaci o nivou HbA1c, učestalosti hipoglikemija na nedeljnom nivou i dnevni glikemijski profili na osnovu kojih su određivani parametri glukozne varijabilnosti.
Rezultati: Vrednost HbA1c je niža nakon terapije insulinskom pumpom u odnosu na vrednosti pre pumpe (p < 0,01). Vrednosti pojedinačnih glikemija iz dnevnih profila, srednja vrednost, standardna devijacija (SD), koeficijent varijacije (CV) i srednja amplituda varijacije glukoze (eng. Mean Amplitude of Glucose Excursion, MAGE) niži su nakon terapije insulinskom pumpom u odnosu na vrednosti pre pumpe (p < 0,05). Uočena je korelacija između HbA1c pre pumpe i SD i MAGE pre pumpe (p < 0,01), HbA1c tri meseca nakon pumpe i SD i MAGE pre pumpe (p < 0,05) i HbA1c šest meseci nakon pumpe i MAGE pre pumpe (p < 0,05), SD tri meseca nakon pumpe (p < 0,01), SD šest meseci nakon pumpe (p < 0,05) i CV tri meseca nakon pumpe (p < 0,01).
Zaključak: Terapijski metod kontinuirane supkutane insulinske infuzije reguliše nivo HbA1c molekula, smanjuje vrednosti svih ispitivanih parametara glukozne varijabilnosti i učestalost hipoglikemija u odnosu na režim multiplih dnevnih insulinskih injekcija.
Ključne reči: Glukozna varijabilnost, insulnska pumpa, hipoglikemija
Reference
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