青少年儿童1型糖尿病患者血糖达标相关因素分析  

Glycemic control and its associated factors in children and adolescents with type 1 diabetes mellitus

作　　者：凌萍 章燕[2] 骆斯慧[1] 郑雪瑛[1] 邱丽玲 杨黛稚[1] 艾鹤英[1] 吕婧[1] 袁凤易 张秀薇[5] 许雯[1] 梁华[1] 严晋华[1] 姚斌[1] 翁建平[1] Ling Ping;Zhang Yan;Luo Sihui;Zheng Xueying;Qiu Liling;Yang Daizhi;Ai Heying;Lu Jing;Yuan Fengyi;Zhang Xiuwei;Xu Wen;Liang Hua;Yah Jinhua;Yao Bin;Weng rianping(Department of Endocrinology and Metabolism,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Key Laboratory of Prevention and Cure of Diabetes,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院内分泌与代谢病学科,广东省糖尿病防治重点实验室,广州510630 [2]南昌大学第一附属医院内分泌科 [3]中山市人民医院内分泌科 [4]深圳市人民医院内分泌科 [5]东莞市人民医院内分泌科

出　　处：《中华医学杂志》2018年第46期3762-3766,共5页National Medical Journal of China

基　　金：广东省科技计划项目(2015A030401034,2017A070713011);中山大学临床研究5010计划(2007030);国家卫生和计划生育委员会公益性行业科研专项(201502011).

摘　　要：目的 探讨持续皮下胰岛素输注治疗的青少年儿童1型糖尿病(T1DM)患者血糖特点及其达标相关因素.方法 研究对象来自2011年6月至2017年8月广东省1型糖尿病转化医学研究.纳入年龄<18岁,使用持续皮下胰岛素输注治疗6个月以上的T1 DM患者.收集人口学特征、自我血糖监测频率(SMBG)以及胰岛素治疗情况等资料.根据糖化血红蛋白(HbA1c)分为达标组(HbA1c<7.5%)和未达标组(HbA1c≥7.5%),多因素logistic回归模型分析血糖达标的相关因素.结果 共142例患者纳入分析(女76例,男66例),年龄13.0(9.9,15.0)岁,病程3.0(1.6,5.0)年,HbA1c(8.2±2.0)%,达标率41.55%(59/142).HbA1c达标组和未达标组SMBG分别为5.0(2.0,8.0)次/d和3.0(1.0,4.0)次/d(P<0.001),低血糖发生频率分别为2.0(0.8,4.0)次/周和1.0(0,2.0)次/周(P=0.003).多因素logistic回归分析结果显示,校正了年龄、病程后,自我血糖监测频率高与血糖达标独立相关(OR=1.238,95%CI:1.088~1.409,P=0.001).结论 对于持续皮下胰岛素输注治疗的青少年儿童1型糖尿病患者,较高频次的自我血糖监测是获得良好血糖控制的关键.Objective To explore the factors associated with glycemic control in children and adolescents with type 1 diabetes mellitus ( T1DM) treated with continuous subcutaneous insulin infusion (CSII).Methods Subjects were enrolled from the Guangdong Type 1 Diabetes Translational Medicine Study between June 2011 and August 2017.Patients with T1DM aged less than 18 years and treated with CSII for at least 6 months were included .Demographic data and clinical information on self-monitoring of blood glucose ( SMBG ), glycosylated hemoglobin ( HbA1c ) and insulin treatment were collected. Participants were categorized based on HbA 1c levels as sufficient control group ( HbA1c <7.5% ) and insufficient control group ( HbA1c≥7.5%).A multivariate logistic regression model was used to examine the factors associated with glycemic control .Results A total of 142 participants (76 females, 66 males) with a median age of 13.0 (9.9, 15.0) years and a median disease duration of 3.0 (1.6, 5.0) years were enrolled.HbA1c was (8.2 ±2.0)%and 41.55%(59/142) of patients achieved the target for HbA1c.The frequency of SMBG was 5.0 (2.0, 8.0) and 3.0 (1.0, 4.0) tests per day (P<0.001), and the frequency of hypoglycemia was 2.0 ( 0.8, 4.0 ) and 1.0 ( 0, 2.0 ) times per week ( P=0.003 ) in sufficient control group and insufficient control group , respectively.Sufficient glycemic control ( HbA1c <7.5%) was associated with the frequency of SMBG (OR=1.238, 95%CI:1.088-1.409, P=0.001).Conclusion A higher frequency of SMBG is one of the key factors to achieve sufficient glycemic control among children and adolescents with T 1DM treated with CSII.

关 键 词：糖尿病 1型 胰岛素输注系统 血红蛋白A 糖基化 青少年 儿童 

分 类 号：R725.8[医药卫生—儿科]