成人脆性1型糖尿病持续皮下胰岛素输注的基础率探讨  

The basal rate characteristics of continuous subcutaneous insulin infusion in adult type 1 diabetes with islet failure

作　　者：孙蔚 陆志强 卞华 

机构地区：[1]复旦大学代谢疾病研究所、复旦大学附属中山医院内分泌科,上海200032

出　　处：《中华内分泌代谢杂志》2017年第10期828-832,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨胰岛功能丧失的成人1型糖尿病持续皮下胰岛素输注（CSII）的基础率特征。方法胰岛功能丧失的成人1型糖尿病、CSII治疗≥12个月但血糖未获良好控制者，采用精确的基础率验证方法进行CSII剂量优化。比较CSII剂量优化前后血糖控制情况和CSII剂量的差异。结果16例患者HbA1C由入选时（7.6±1.1）%降至优化后的（7.0±0.5）%（P〈0.05），最低血糖由（3.1±1.1）mmol/L升至（4.5±0.7）mmol/L（P〈0.01），最高血糖由（18.6±2.3）mmol/L降至（12.0±1.5）mmol/L（P〈0.01）。每日胰岛素总量较入选时减少了约17%（P〈0.01），每日基础率总量较入选时减少约43%（P〈0.01），每日基础率/胰岛素总量百分比由入选时的（43.6±9.9）%降至（29.4±3.5）%（P〈0.01）。在24h中，03∶00-08∶00基础率为日最高峰，约为每小时平均基础率的1.3倍；20∶00-24∶00基础率为日最低谷，约为每小时平均基础率的60%。结论胰岛功能丧失的成人1型糖尿病CSII基础率需要量约为胰岛素总量的30%，03∶00-08∶00基础率为日最高峰，20∶00-24∶00基础率为日最低谷。Objective To investigate the basal rate characteristics of continuous subcutaneous insulin infusion（CSII）in adult type 1 diabetes with islet failure.Methods Adult type 1 diabetic patients with islet failure, treated by CSII for more than 12 months but with poor glycemic control, were optimized for insulin dose through basal rate verification. The differences of blood glucose levels and insulin dosages were compared before and after CSII dose optimization.Results In 16 cases, HbA1C reduced from（7.6±1.1）% by the time of enrollment to（7.0±0.5）% after dose optimization（P〈0.05）, the minimal blood glucose level rose from（3.1±1.1）mmol/L to（4.5±0.7）mmol/L（P〈0.01）, and the maximal blood glucose level dropped from（18.6±2.3）mmol/L to（12.0±1.5）mmol/L（P〈0.01）. The total daily dosage of CSII reduced by about 17%（P〈0.01）and the total basal insulin dosage reduced by about 43%（P〈0.01）after dose optimization. The percentage of total basal insulin dosage to total daily dosage reduced from（43.6±9.9）% by the time of enrollment to（29.4±3.5）% after dose optimization（P〈0.01）. During 24 hours of the day, basal rate at 03∶00-08∶00 reached the peak level（1.3 times of the hourly average basal rate level）and basal rate at 20∶00-24∶00 fell to the valley level（60% of the hourly average basal rate level）. Conclusions In adult type 1 diabetic patient with islet failure, the total basal insulin requirement of CSII is about 30% of the total daily dosage, with the peak level at 03∶00-08∶00 and the valley level at 20∶00-24∶00.

关 键 词：糖尿病 1型 脆性糖尿病 持续皮下胰岛素输注 基础率 

分 类 号：R587.1[医药卫生—内分泌]