起病年龄对成年1型糖尿病患者代谢控制的影响  

Effect of onset age of diabetes on metabolic control in adult with type 1 diabetes mellitus

作　　者：魏雪盈 杨黛稚[1] 骆斯慧 王超凡 林琼艳 严晋华[1] 姚斌[1] 翁建平 郑雪瑛[1] Wei Xueying;Yang Daizhi;Luo Sihui;Wang Chaofan;Lin Qiongyan;Yan Jinhua;Yao Bin;Weng Jianping;Zheng Xueying(Department of Diabetes and Metabolism,the Third Affiliation Hospital of Sun Yat-Sen University,Guangdong Diabetes Prevention and Control Research Center,Guangdong Provincial Key Laboratory of Diabetology,Guangzhou 510630,China;Department of Endocrinology,the First Affiliated Hospital of University of Science and Technology(Anhui Provincial Hospital),Hefei 230001,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研究中心广东省糖尿病防治重点实验室,广州510630 [2]中国科学技术大学附属第一医院(安徽省立医院)内分泌与代谢病学科,合肥230001

出　　处：《中华糖尿病杂志》2020年第6期393-397,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家重点研发计划(2016YFC1305002,2017YFC1309600);中央高校基本科研业务费专项基金资助(WK9110000137);广东省基础与应用基础研究基金(2019A151501097)。

摘　　要：目的探讨起病年龄对成年1型糖尿病(T1DM)患者代谢控制的影响。方法选取广东省1型糖尿病转化医学研究数据库中2011年1月至2017年12月入组的成年T1DM患者作为研究对象(糖尿病病程超过1年,入组时年龄≥18岁)。收集患者人口学资料和糖化血红蛋白(HbA1c)、体质指数(BMI)、血脂、血压等代谢指标。采用成人T1DM胰岛素抵抗估算模型计算葡萄糖处置率(eGDR)作为胰岛素抵抗程度的评价指标,分析起病年龄与代谢指标、胰岛素抵抗之间的关系。采用偏相关分析剔除糖尿病病程影响后,分析起病年龄与HbA1c和胰岛素抵抗的相关性。结果(1)共入选872例T1DM患者,其中508例(58.3%)为女性;受访时平均年龄(33±11)岁,平均起病年龄(27±12)岁,平均病程(8±6)年。(2)总体人群代谢控制情况:平均HbA1c(8.9±2.6)%,达标率(HbA1c<7%)23.8%(208例);平均BMI为(20.8±2.8)kg/m^2,体重达标率(BMI 18.5~23.9 kg/m^2)89.7%(782例);26.3%(61例)患者血脂紊乱(甘油三酯≥1.7 mmol/L或高密度脂蛋白胆固醇<1.04 mmol/L);平均血压(116±15)/(73±9)mmHg(1 mm Hg=0.133 kPa),达标率(<130/85 mmHg)88.4%(691例);血糖、体重、血压和血脂四项均达标的比例仅26例(3.0%)。平均eGDR为8.84(6.84,10.79)mg·kg^-1·min^-1。(3)与成年人起病组相比,儿童及青少年期起病的成年T1DM患者平均HbA1c更高(F=4.863,P<0.05),胰岛素抵抗更严重(F=3.177,P<0.05);与其他两组相比,儿童期起病的成年T1DM患者HbA1c达标率和血脂达标率更低(F=2.943、3.404,均P<0.05)。结论中国广东省成人T1DM患者中,起病年龄越早,代谢紊乱越明显,胰岛素抵抗越严重,需根据患者起病年龄的不同而制定个体化方案。Objective To evaluate the effect of onset age of diabetes on metabolic control in adult patients with type 1 diabetes mellitus(T1DM).Methods Adults with T1DM from Guangdong type 1 diabetes translational study between Janurary 2011 to December 2017 were enrolled in this cross-over survey.Patients were eligible if they were aged≥18 years with diabetes duration longer than 1 years.Demographic data,glycated hemoglobin A1c(HbA1c),body mass index(BMI),lipid level,blood pressure(BP)and other metabolic indicators were collected.Insulin resistance in adults with T1DM was evaluated by estimate glucose disposal rate(eGDR)model calculation.The effects of onset age of diabetes on metabolic control and insulin resistance in adult patients with T1DM were evaluated.Partial correlation analysis was used to analyze the correlation between the onset age of diabetes and HbA1c or insulin resistance after eliminating the influence of the course of diabetes.Results(1)A total of 872 T1DM adults including 508(58.3%)female patients with disease duration over 1 year were enrolled.The mean age was(33±11)years old,the mean onset age was(27±12)years and the mean diabetic duration was(8±6)years.(2)The overall mean HbA1c level for all patients was(8.9±2.6)%,and 23.8%(n=208)of them had HbA1c<7%.The mean BMI for all patients was(20.8±2.8)kg/m^2,and 89.7%(n=782)of them had BMI 18.5 to 23.9 kg/m^2.26.3%(n=61)patients were dyslipidemia(TG≥1.7 mmol/L or HDL-C<1.04 mmol/L).The mean BP for all patients was(116±15)/(73±9)mmHg(1 mmHg=0.133 kPa),and 88.4%(n=691)of them achieved the recommended BP control target.Only 26 patients(3.0%)reached the control standard in blood glucose,body weight,blood pressure and blood lipids.The overall eGDR was 8.84(6.84,10.79)mg·kg^-1·min^-1.(3)Children and adolescent onset patients had a higher mean HbA1c(F=4.863,P<0.05)and a severer insulin resistance(F=3.177,P<0.05)compared with adult onset diabetic patients.The control rate of HbA1c and serum lipid in children onset patients were lower compared with those i

关 键 词：糖尿病 1型 起病年龄 代谢控制 

分 类 号：R587.1[医药卫生—内分泌]