BACKGROUND. Hypoglycemia and fear of hypoglycemia remain critical problems in the treatment of adolescents with type 1 diabetes mellitus (DM1) and are factors limiting proper control of glycemia and preventing the achievement of metabolic compensation of the disease. The use of pump insulin therapy involves the prevention of hypoglycemic conditions. AIM. To analyze the frequency and duration of hypoglycemia episodes, their effect on the metabolic compensation of the disease in adolescents with type 1 diabetes mellitus (DM1) in real clinical practice, depending on the mode/method of insulin administration. MATERIALS AND METHODS. The study involved 117 adolescents with DM1 aged 12 to 19 years (average age 15.5 years). 37 adolescents received therapy by continuous subcutaneous insulin infusion (CSII); 80 adolescents received therapy by multiple insulin injections (MII). The level of glycated hemoglobin (HbA 1c ) was determined for all adolescents, and its main indicators were evaluated using a 6 days continuous glucose monitoring (CGM) by the «blind» method of a professional system with an iPro 2 sensor (Medtronic MiniMed, USA). RESULTS. Episodes of a decrease in glucose levels <3,9 mmol/l were recorded in 87% of patients (n=102), 63% (n=74) showed a decrease in glucose levels <3,0 mmol/l. Episodes decrease in glucose levels <3,9 mmol/l at night were recorded in 68% of patients (n=80), and with glucose levels <3,9 mmol/l in 46% (n=54). The frequency of episodes of glucose lowering <3,9 mmol/l had no statistically significant differences depending on the methods of insulin administration (by continuous subcutaneous insulin infusion or multiple insulin injections), however, they are more common in adolescents with HbA 1c <7,0% (p=0,03). The median time spent by patients in the range of <3,9 mmol/l was 5% per day, and a longer time in this range was observed in patients with HbA 1c <7,0% (p=0,006). The median time in the range of <3,0 mmol/l was 1% per day and had no significant differences depending on the level of HbA 1c (p=0,559). There were also no significant differences depending on the groups using CSII and MII (p=0,640 and p=0,250). CONCLUSION. Episodes of glucose reduction in the range of <3,9 mmol/l according to CGM data are more common in adolescents with HbA 1c target values, regardless of the method of insulin administration. Significantly more time in range of <3,9 mmol/l is spent by adolescents with target values of HbA 1c i.е. <7,0% compared with HbA 1c ≥7,0%, however, in both groups, a large number of patients had time in the range below the target level was higher than recommended values.

ВАРИАБЕЛЬНОСТЬ ГЛИКЕМИИ У ПОДРОСТКОВ С САХАРНЫМ ДИАБЕТОМ 1 ТИПА, ИСПОЛЬЗУЮЩИХ РАЗНЫЕ МЕТОДЫ ВВЕДЕНИЯ ИНСУЛИНАЦаргасова И .М ., Башнина Е

9312-13 июня 2021 г. РОЛЬ ПРИВЕРЖЕННОСТИ К ПОМПОВОЙ ИНСУЛИНОТЕРАПИИ ПРИ ДЛИТЕЛЬНОСТИ САХАРНОГО ДИАБЕТА 1 ТИПА БОЛЕЕ ТРЕХ ЛЕТИ.М.Царгасова, О

СБОРНИК ТЕЗИСОВ XVII Российская научно-практическая конференция детских эндокринологов «Достижения науки в практику детского эндокринолога» ЗНАЧЕНИЕ НЕПРЕРЫВНОГО МОНИТОРИРОВАНИЯ ГЛИКЕМИИ В ПОДДЕРЖАНИИ МЕТАБОЛИЧЕСКОЙ КОМПЕНСАЦИИ САХАРНОГО ДИАБЕТА 1 ТИПА У ДЕТЕЙ И ПОДРОСТКОВ И.М.Царгасова, Е

BACKGROUND: Insulin pumps (IP) are a widespread treatment for type 1 diabetes mellitus (T1D) in children because of its several advantages over multiple insulin injection regimens (MII). However, the long-term effectiveness of continuous subcutaneous insulin infusion (CSII) in achieving and maintaining sustained metabolic compensation remains controversial. OBJECTIVE: To determine the factors affecting the long-team effectiveness of CSII in children and adolescents with T1DM in real clinical practice. METHODS: Data of 239 children and adolescents treated with CSII for ≥3 years were examined during the registration of patients receiving insulin pump therapy in Saint-Petersburg was formed. HbA1с level changes over time were analysed before switching to CSII and were assessed depending on sex and age, baseline HbA1с level and factors as the frequency of using continuous glucose monitoring (CGM), temporary transitions from CSII to MII with injection pens and use of bolus calculators (BC). RESULTS: The final HbA1с value showed no significant changes as compared with the HbA1с level before switching to CSII (baseline, 7.82±1.46%; final, 7.93±1.30%). Approximately 42% of patients had HbA1с level of <7.5%. Better results were observed in the 4.5–7-year age group, where 67% of patients had HbA1с level of <7.5%; in 12–18-year age group, only 35% of patients reached the target HbA1с level. Majority of patients with baseline HbA1с level of <7.5% remained within the target level during the final examination, whereas only 23% of patients with HbA1с level of ≥7.5% before switching to CSII reached the target level. Better glycaemic control was also observed in patients treated with CSII regularly, as compared to patients who periodically switched to MII with the injection pen (p<0.05). HbA1с appeared to be lower in the group of 12–18-year-old adolescents who used CGM regularly, as compared to the group not treated with CGM (p<0.05). CONCLUSION: Children and adolescents treated with CSII for ≥3 years did not experience a significant improvement in metabolic control. However, the influence of factors in maintaining the metabolic control, such factors as the patient’s age, initial HbA1с level, CGM use and frequency, and the presence or absence of changes in insulin therapy regimen is observed.