儿童新发1型糖尿病院外治疗及监测方案对糖化血红蛋白的影响  

Effect of out-of-hospital therapy and monitoring plans on glycosylated hemoglobin in children with newly diagnosed type 1 diabetes mellitus

作　　者：陶娜[1] 许丽君 黄奇[1] 孙美媛 杨旭[1] 张艳蓉 刘晓梅[1] TAO Na;XU Lijun;HUANG Qi;SUN Meiyuan;YANG Xu;ZHANG Yanrong;LIU Xiaomei(Department of Endocrinology,Genetics and Metabolism,the Children′s Hospital Affiliated to Kunming Medical University,Kunming,Yunnan,650000)

机构地区：[1]昆明医科大学附属儿童医院内分泌遗传代谢科,云南昆明650000

出　　处：《实用临床医药杂志》2023年第11期70-74,共5页Journal of Clinical Medicine in Practice

基　　金：云南省科技厅科技计划项目(202001AY070001-274)。

摘　　要：目的分析儿童新发1型糖尿病(T1DM)院外血糖控制情况,探讨不同的治疗方案和血糖监测方式对糖化血红蛋白(HbA1c)的影响。方法回顾性分析昆明医科大学附属儿童医院内分泌遗传代谢科收治的新发T1DM患儿的临床资料,以出院9个月内HbA1c中位数为标准(7.0%),分为达标组和未达标组。将患儿根据胰岛素注射方式分为胰岛素泵持续皮下胰岛素输注(CSII)组及多次胰岛素皮下注射(MDI)组;根据治疗方案联合监测方案分为4组,即持续皮下胰岛素输注联合瞬感扫描式葡萄糖监测组(CSII联合FGMS组)、持续皮下胰岛素输注联合自我血糖监测组(CSII联合SMBG组)、多次胰岛素皮下注射联合瞬感扫描式葡萄糖监测组(MDI联合FGMS组)、多次胰岛素皮下注射联合自我血糖监测组(MDI联合SMBG组)。比较治疗方案及血糖监测方式对新发T1DM患儿血糖控制的影响。结果共有48例新发T1DM患儿纳入本研究,其中HbA1c达标组(n=15)患儿年龄更小,CSII使用率及FGMS使用率更高,低血糖发生次数更少,差异均有统计学意义(P<0.05);2组患儿性别、居住环境、监护人文化程度、体质量指数(BMI)、血糖监测频率比较,差异均无统计学意义(P>0.05)。CSII组患儿年龄更小,CSII组HbA1c降低效果优于MDI组,差异有统计学意义(P<0.05)。治疗方案联合监测方案的分析中,CSII联合FGMS组在快速降低HbA1c幅度方面优于MDI联合SMBG组,差异有统计学意义(P<0.05)。结论新发T1DM患儿血糖控制情况总体仍欠佳,血糖达标率低。新发T1DM患儿出院3个月内使用FGMS有助于HbA1c的控制,连续9个月CSII治疗在快速降低HbA1c方面的效果优于MDI治疗。长期治疗及监测中,CSII联合FGMS的效果更佳。Objective To analyze the condition of out-of-hospital blood glucose control in children with newly diagnosed type 1 diabetes mellitus(T1DM),and to explore the effects of different therapies and monitoring methods for blood glucose on glycosylated hemoglobin(HbA1c).Methods The clinical materials of children with newly diagnosed T1DM in the Department of Endocrinology,Genetics and Metabolism in the Children's Hospital Affiliated to Kunming Medical University were retrospectively analyzed,and the children were divided into standard group and non-standard group based on the standard of the median HbA1c(7.0%)within 9 months after discharge.According to the way of insulin injection,the children were divided into continuous subcutaneous insulin infusion(CSII)group by insulin pump or multiple daily injection(MDI)group;according to the combinations of therapies and monitoring plans,the children were divided into four groups,including continuous subcutaneous insulin infusion plus instantaneous scanning glucose monitoring group(CSII plus FGMS group),continuous subcutaneous insulin infusion plus self-monitoring blood glucose group(CSII plus SMBG group),multiple subcutaneous insulin injection plus instantaneous scanning glucose monitoring group(MDI plus FGMS group),and multiple insulin subcutaneous injection plus self-monitoring blood glucose group(MDI plus SMBG group).The effects of therapies and monitoring methods for blood glucose on blood glucose control in children with newly diagnosed T1DM were compared.Results A total of 48 children with newly diagnosed T1DM were included in this study.In the HbA1c standard group(n=15),the children were significantly younger,the usage rates of CSII and FGMS were significantly higher,and the frequency of hypoglycemia was significantly less(P<0.05);there were no significant differences in gender,living environment,educational level of guardians,body mass index(BMI)and monitoring frequency of blood glucose between two groups(P>0.05).The children in the CSII group were significantly younge

关 键 词：1型糖尿病 糖化血红蛋白 院外血糖控制 持续皮下胰岛素输注 多次胰岛素皮下注射 

分 类 号：R725.8[医药卫生—儿科] R816.92[医药卫生—临床医学]