ISSN 2490-3329 (Print)
ISSN 2303-7954 (Online)

Godina 48, Broj 1, Članak 7

(Scr Med 2017:48:45-52)
ORIGINALNI RAD

Značaj upotrebe bolus kalkulatora za poboljšanje glikoregulacije kod pacijenata na terapiji inzulinskom pompom

Bojana Carić1,2, Katarina Lalić3,4, Saša Marin5, Ljubica Stošić4, Snježana Popović Pejičić1,2

1Univerzitetski klinički centar Republike Srpske, Banja Luka; Klinika za unutrašnje bolesti
2Medicinski fakultet Univerziteta u Banjoj Luci, Republika Srpska
3Medicinski fakultet Univerziteta u Beogradu, Srbija
4Klinika za endokrinologiju, dijabetes i bolesti metabolizma Kliničkog centra Srbije, Beograd
5Medicinski fakultet Univerziteta u Banjoj Luci, Studijski program stomatologija, Katedra za oralnu hirurgiju, Republika Srpska

 

doi: 10.18575/msrs.sm.s.17.07
UDK 616-002-074:612.018
COBISS.RS-ID 6393880

 

SAŽETAK
Uvod: Bolus kalkulator predstavlja naprednu funkciju inzulinske pumpe (IP) čijom se upotrebom povećava preciznost izračuna odgovarajuće doze inzulina za obrok, odnosno korektivne doze inzulina, kod pacijenata sa tipom 1 dijabetesa (T1D).

Cilj rada: Uporediti razliku u parametrima glikoregulacije (HbA1c, postprandijalnog porasta glikemije, broja hipoglikemijskih epizoda u nedjelji dana) između grupe pacijenata koji bolus kalkulator koriste za <50% ukupno datih dnevnih bolusa i grupe pacijenata koji bolus kalkulator koriste za ≥50% ukupno datih dnevnih bolusa.

Ispitanici i metode: U studiji je učestvovalo 36 pacijenata starijih od 18 godina koji su liječeni IP najmanje godinu dana prije početka istraživanja. Prije inicijacije terapije IP, obavljena je strukturisana edukacija po principima fleksibilne inzulinske terapije u okviru koje su pacijenti obučeni za korištenje metode »brojanja ugljenih hidrata«. Profesionalni softver, CareLink Pro® Software (Medtronic Inc., Northridge,CA, USA) za praćenje liječenja T1D je korišten za preuzimanje podataka sa IP na personalni računar. Podrazumijevana frekvenca upotrebe bolus kalkulatora iznosila je ≥50% svih datih bolusa tokom dana.

Rezultati: Nije uočena statistički značajna razlika ni u HbA1c (6,61 ± 1,10 vs. 6,56 ±0,84, p = 0,896) niti u broju hipoglikemijskih epizoda (2,00 (1,00, 4,00) (1,0 - 6,0) vs 3,00 (2,00, 4,00) (1,0 - 5,0), p = 0,298) između grupe pacijenata koji su koristili bolus kalkulator za <50% ukupno datih bolusa i grupe pacijenata koji bolus kalkulator koristili za ≥50% ukupno datih bolusa. Pacijenti koji su koristili bolus kalkulator imali su signifikantno manji postprandijalni porast glikemije nakon doručka.

Zaključak: Da bi se maksimalno iskoristile sve prednosti IP, potrebne su redovne reedukacije i pacijenata i dijabetologa o naprednim funkcijama IP, što bi doprinijelo njihovoj redovnoj upotrebi i poboljšanju glikoregulacije u T1D.

Ključne riječi: Inzulinska pumpa, bolus kalkulator, T1D, glikoregulacija

 

PDF verzija članka

 

Reference
1. Pickup JC. Insulin-pump therapy for type 1 diabetes mellitus. N Engl J Med. 2012 Apr 26;366(17):1616-24. https://doi.org/10.1056/NEJMct1113948 PMid:22533577
2. Battelino T, Conget I, Olsen B, et al. The use and effi cacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012;55(12):3155–3162. https://doi.org/10.1007/s00125-012-2708-9 PMid:22965294 PMCid:PMC3483098
3. Hermanides J, Nørgaard K, Bruttomesso D, et al. Sensor augmented pump therapy lowers HbA1c in suboptimally controlled type 1 diabetes; a randomized controlled trial. Diabet Med. 2011;28(10):1158–1167. https://doi.org/10.1111/j.1464-5491.2011.03256.x PMid:21294770
4. Shalitin S, Phillip M. : Closing the loop: combining insulin pumps and glucose sensors in children with type 1 diabetes mellitus. Pediatr Diabetes 2006; 7 (Suppl. 4): 45– 49. https://doi.org/10.1111/j.1399-543X.2006.00170.x PMid:16774618
5. Phillip M, Battelino T, Atlas E, Kordonouri O, Bratina N, Miller S et al Nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med 2013; 368:824–833 https://doi.org/10.1056/NEJMoa1206881 PMid:23445093
6. Kovatchev BP, Renard E, Cobelli C, Zisser HC, KeithHynes P, Anderson SM et al Safety of outpatient closedloop control: first randomized crossover trials of a wearable artificial pancreas. Diabetes Care 2014; 37: 1789–1796. https://doi.org/10.2337/dc13-2076 PMid:24929429 PMCid:PMC4067397
7. Thabit H, Lubina-Solomon A, Stadler M, Leelarathna L, Walkinshaw E, Pernet A et al Home use of closed-loop insulin delivery for overnight glucose control in adults with Type 1 diabetes: a 4–week, multicentre, randomised crossover study. Lancet Diabetes Endocrin 2014; 2: 701–709. https://doi.org/10.1016/S2213-8587(14)70114-7
8. Sherr JL, Palau Collazo M, Cengiz E, Michaud C, Carria L, Steffen AT et al Safety of nighttime 2-hour suspension of basal insulin in pump-treated Type 1 diabetes even in the absence of low glucose. Diabetes Care 2014; 37: 773–779. https://doi.org/10.2337/dc13-1608 PMid:24170766 PMCid:PMC3931387
9. Wolpert H, Kavanagh M, Atakov-Castillo A, Steil GM. The artificial pancreas: evaluating risk of hypoglycaemia following errors that can be expected with prolonged at home use. Diabet Med. 2016 Feb;33(2):235-42 https://doi.org/10.1111/dme.12823 PMid:26036309 PMCid:PMC5008188
10. Walsh J, Roberts R, Bailey T. Guidelines for insulin dosing in continuous subcutaneous insulin infusion using new formulas from a retrospective study of individuals with optimal glucose levels. J Diabetes Sci Technol. 2010;4(5):1174-1181. https://doi.org/10.1177/193229681000400516 PMid:20920437 PMCid:PMC2956816
11. Walsh J, Roberts R, Heinemann L. Confusion regarding duration of insulin action: a potential source for major insulin dose errors by bolus calculators. J Diabetes Sci Technol. 2014;8(1):170-178. https://doi.org/10.1177/1932296813514319 PMid:24876553 PMCid:PMC4454113
12. Zisser H, Robinson L, Bevier W, et al. Bolus calculator: a review of four “smart” insulin pumps. Diabetes Technol Ther. 2008;10(6):441-444. https://doi.org/10.1089/dia.2007.0284 PMid:19049372
13. Schmidt S, Nørgaard K. J Bolus calculators. Diabetes Sci Technol. 2014 Sep;8(5):1035-41. https://doi.org/10.1177/1932296814532906 PMid:24876436 PMCid:PMC4455388
14. DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type1 diabetes: Dose Adjustment for Normal Eating (DAFNE) randomised controlled trial. BMJ. 2002;325(7367):746. https://doi.org/10.1136/bmj.325.7367.746
15. Cukierman-Yaffe T, Konvalina N, Cohen O. Key elements for successful intensive insulin pump therapy in individuals with type 1 diabetes. Diabetes Res Clin Pract. 2011;92(1):69-73. https://doi.org/10.1016/j.diabres.2011.01.002 PMid:21292340
16. Boizel R, Pinget M, Lachgar K, et al. Clinical Evaluation of the Use of a Multifunctional Remotely Controlled Insulin Pump: Multicenter Observational Study. J Diabetes Sci Technol. 2014 Nov; 8(6): 1145–1150. https://doi.org/10.1177/1932296814545670 PMid:25107708 PMCid:PMC4455473
17. Kerr D, Hoogma RP, Buhr A, Petersen B, Storms FE, for the study investigators. Multicenter User Evaluation of ACCU-CHEK® Combo, an Integrated System for Continuous Subcutaneous Insulin Infusion.J Diabetes Sci Technol. 2010 Nov; 4(6): 1400–1407. https://doi.org/10.1177/193229681000400615 PMid:21129336 PMCid:PMC3005051
18. Joubert M, Morera J, Vincete A, Rod A, Parienti JJ, Reznik Y. Cross-sectional Survey and Retrospective Analysis of a Large Cohort of Adults With Type 1 Diabetes With Long-Term Continuous Subcutaneous Insulin Infusion Treatment. J Diabetes Sci Technol. 2014 Sep; 8(5): 1005–1010. https://doi.org/10.1177/1932296814537040 PMid:24876454 PMCid:PMC4455364
19. Riveline JP, Jollois FX, Messaoudi N et al. Insulin-pump use in everyday practice: data from an exhaustive regional registry in France. Diabetes Metab. 2008 Apr;34(2):132-9. https://doi.org/10.1016/j.diabet.2007.10.010 PMid:18289909
20. Klupa T, Benbenek-Klupa T, Malecki M, et al. Clinical usefulness of a bolus calculator in maintaining normoglycaemia in active professional patients with type 1 diabetes treated with continuous subcutaneous insulin infusion. J Int Med Res. 2008;36(5):1112-1116. https://doi.org/10.1177/147323000803600531 PMid:18831908
21. Enander R, Gundevall C, Strömgren A, Chaplin J, Hanas R. Carbohydrate counting with a bolus calculator improves postprandial blood glucose levels in children and adolescents with type 1 diabetes using insulin pumps. Pediatr Diabetes. 2012 Nov;13(7):545-51. https://doi.org/10.1111/j.1399-5448.2012.00883.x PMid:22776045
22. Shashaj B, Busetto E, Sulli N.Benefi ts of a bolus calculator in pre and postprandial glycaemic control and meal fl exibility of paediatric patients using continuous subcutaneous insulin infusion (CSII). Diabet Med. 2008;25(9):1036-1042. https://doi.org/10.1111/j.1464-5491.2008.02549.x PMid:18937673
23. Alemzadeh R, Palma-Sisto P, Parton EA, Holzum MK. Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes. Diabetes Technol Ther. 2005 Aug;7(4):587-96. https://doi.org/10.1089/dia.2005.7.587 PMid:16120030
24. Gross TM, Kayne D, King A, Rother C, Juth S. A bolus calculator is an effective means of controlling postprandial glycemia in patients on insulin pump therapy. DiabetesTechnol Ther. 2003;5(3):365-9. https://doi.org/10.1089/152091503765691848 PMid:12828818
25. Taki K, Nishimura R, Morimoto A, Tsujino D, Miyashita Y, Tajima N. Analysis of 24-hour glycemic excursions in patients with type 1diabetes by using continuous glucose monitoring. Diabetes Technol Ther. 2010 Jul;12(7):523-8).https://doi.org/10.1089/dia.2009.0167 PMid:20597826
26. Lawton J, Kirkham J, Rankin D, Barnard K, Cooper CL, Taylor C, Heller S, Elliott J; REPOSE Group. Perceptions and experiences of using automated bolus advisors amongst people with type 1 diabetes: a longitudinal qualitative investigation. Diabetes Res Clin Pract. 2014 Dec;106(3):443-50. https://doi.org/10.1016/j.diabres.2014.09.011 PMid:25451897 PMCid:PMC4270460
27. Klupa T, Skupien J, Cyganek K, Katra B, Sieradzki J,Malecki MT. The dual-wave bolus feature in type 1 diabetes adult users of insulin pumps. Acta Diabetol. 2011;48(1):11–4. https://doi.org/10.1007/s00592-009-0173-9 PMid:20063022
28. Chase HP, Saib SZ, MacKenzie T, Hansen MM, Garg SK.Postprandial glucose excursions following four methods of bolus insulin administration in subjects with type 1 diabetes. Diabet Med. 2002;19(4):317–21. https://doi.org/10.1046/j.1464-5491.2002.00685.x PMid:11943004
29. Jones SM, Quarry JL, Caldwell-McMillan M, Mauger DT, Gabbay RA. Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. Diabetes Technol Ther. 2005;7(2):233–40. https://doi.org/10.1089/dia.2005.7.233 PMid:15857224
30. Pankowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther. 2012;14(1):16–22. https://doi.org/10.1089/dia.2011.0083 PMid:22013887
31. Schwartz FL, Guo A, Marling CR, Shubrook JH. Analysis of use of an automated bolus calculator reduces fear of hypoglycemia and improves confi dence in dosage accuracy in type 1 diabetes mellitus patients treated with multiple daily insulin injections. J Diabetes Sci Technol. 2012 Jan 1;6(1):150-2. https://doi.org/10.1177/193229681200600118 PMid:22401333 PMCid:PMC3320832 Pal

 

Kontakt adresa:
Bojana Carić
Klinika za unutrašnje bolesti,
Univerzitetski klinički centar
Republike Srpske
12 beba b.b.
78000 Banja Luka,
Republika Srpska
Bosna i Hercegovina
e-mail: Ова адреса ел. поште заштићена је од спам напада, треба омогућити ЈаваСкрипт да бисте је видели
telefon: +387-65-841-294

Rad primljen: 8.2.2017.
Rad prihvaćen: 22.2.2017.