胰岛素泵临床应用.ppt

胰岛素泵临床应用
2022/5/16
1
一、胰岛素泵的应用基础与现状
糖尿病检测技术的进展史
Insulin Injections
Urine Test Strips
Glucose Sensor
Artific胰岛素泵临床应用
2022/5/16
1
一、胰岛素泵的应用基础与现状
糖尿病检测技术的进展史
Insulin Injections
Urine Test Strips
Glucose Sensor
ArtificialPancreas
2019
1978
1922
1900s
1977
Urine Tasting
1776
BG Meters
Insulin Pump Therapy
胰岛素泵的应用病例数（不完全统计数）
DCCT
DCCT: Diabetes Care 2019; 18:361-376
正常胰岛素分泌规律
胰岛素泵模拟胰岛素分泌
Basal Rate
Pancreas Delivery
Meal
Boluses
Pharmacokinetic Advantages:CSII vs MDI
Uses only Regular insulin
More predictable absorption than with modified insulins (variation 3% vs 52%*)
Uses one injection site for 2 to 3 days
Reduces variations in absorption due to site rotation
Eliminates most of the subcutaneous insulin depot
Programmable insulin delivery allows closest match with physiologic needs
* Lauritzen: Diabetologia 1983; 24:326-9
胰岛素泵的优点
降低HbA1c
减少低血糖
提高生活质量
降低治疗费用
HbA1C每增加1%，将增加以下并发症发生危险
胰岛素泵 降低了低血糖的发生率
低血糖减少后的益处：
减少了低血糖脑病
减少了低血糖的死亡
提高了患者对低血糖的感知
Lifetime Benefits of EffectiveIntensive Therapy (DCCT)
Gain of years of complication free living compared to conventional therapy
Gain of years of life compared to conventional therapy
DCCT Study Group, JAMA 2019;276:1409-1415.
降低医疗开支
HbA1c 7% 8% 9% 10%
Indirect $1,000 $21,400 $44,900 $61,700
Direct $108,400 $109,300 $122,900 $145,600
DirectCosts
DirectCosts
DirectCosts
DirectCosts
Assumption: Patients follow typical scenario. Dollars are Expected Net Present Value
Source: Quattro CSII Economic Analysis Model 2019
Improved Quality of Life
Pump patients demonstrate:
Lower anxiety and depression scores
Greater family cohesion
Improved interpersonal sensitivity
Significantly less distress from hypoglycemia
Coping with diabetes less difficult (adolescents)
二、胰岛素泵的应用方法
胰岛素剂量的分配
50%
Basal
Pre-Pu