儿童1型糖尿病管理十年前后对比及相关因素分析

doi:10.3969/j.issn.1006-7795.2013.04.023

摘要/Abstract

摘要：

目的比较近10年来糖尿病管理血糖控制改善情况,并分析影响血糖控制相关因素。方法横断面调查2011年12月至2012年5月在北京儿童医院糖尿病门诊复诊的病程1年以上、1型糖尿病儿童158例(A组)的血糖控制及合并症情况,并与10年前123例(B组)横断面调查比较。采用分组比较,线性相关回归分析血糖控制的影响因素。结果 2组均无并发症患儿。平均糖化血红蛋白A1C(hemoglobin A1C,HbA1C)(8.5±1.47)% vs (9.9±1.85)%,下降1.4%,差异有统计学意义(P=0.000)。按患儿性别分组,男女患儿HbA1C在前后10年相比较,差异有统计学意义(P=0.000和0.008)。男童HbA1C良好及中等达标率后前10年检测结果分别为16.4%、68.5% vs 2.4%、58.9%,差异有统计学意义(P=0.000)。男女2组不同年代1日2次胰岛素注射比例及自我血糖监测(self-monitoring blood glucose,SMBG)比较,差异有统计学意义(P=0.000)。线性相关分析显示,HbA1C与年龄、病程、胰岛素用量成正相关,与SMBG成负相关。线性回归分析显示病程对于HbA1C起主要作用。社会经济因素调查统计学上未见家庭经济收入、父母知识层次对于血糖控制的影响,但血糖控制良好组,父母知识层次高的比例稍多于其他2组,血糖控制差组看病自付比例较高。约半数糖尿病患儿家庭经济收入低于社会平均水平,看病费用超过家庭总收入的1/3。结论近10年来,在北京儿童医院就诊的1型糖尿病(type 1 diabetes mellitus,T1DM)发病年龄更小、女孩更多、SMBG增加、胰岛素注射每日2次比例不足一半。病程是影响血糖达标与否的最重要因素。儿童期未见合并症发生。前后10年胰岛素注射方式发生改变,加强血糖监测有助于改善血糖控制。社会经济因素显示部分糖尿病患儿家庭经济收入低于社会平均水平。看病费用增加家庭负担。

关键词: 1型糖尿病, 血糖控制, 自我血糖监测, 胰岛素注射方式

Abstract:

Objective To compare of anterior-posterior decade glycemic control with improvement of diabetes management and evaluate influence of socioeconomic factors on glycemic control. Methods This cross-sectional clinical-based survey enrolled 158 T1DM children on December 2011 to May 2012(Group A) in Beijing children's hospital of more than one year management and compared with 123 T1DM children who were recruited in Asia and the West Pacific Region T1DM Study on December 2001 to May 2002(Group B) in Beijing children's hospital. Normally distributed data are reported as mean±SD, skewed data as median±interquartile range. Linear correlation and regression analysis were performed for glycemic control. Results There is no complication in both two groups. The average of HbA1C was 8.3±1.53%, better than ten years before 9.9±1.85 %(P=0.000). The ratio of optimal and suboptimal HbA1C of boys in group A and B were 16.4%, 68.5% vs 2.4%, 58.9%, P=0.000 respectively. The ratio of insulin injection twice daily and the frequency of SMBG in group A and B both girls and boys are statistically significant difference P=0.000 respectively. HbA1C was positive correlation with age, duration, insulin dosage per day and diabetic care costs by family while inverse correlation with frequency of SMBG in liner correlation and regression analysis. It was showed that duration was the most important factor. Socioeconomic survey showed that household income and parents' knowledge and educational levels did not affect glycemic control significantly in statistic. But there is a higher percentage of parents' knowledge and educational levels in optional subgroup than in the other two subgroups. About half of diabetic children whose household income were lower than the average level and their diabetic care costs were over 1/3 household income. Conclusion There were younger and more girls of type 1 dibetic children in Beijing children's hospital. The frequency of SMBG and the ratio of MDI and CSII were increasing significantly ten years after. Duration was the most important factor of glycemic control. There was no complication in children. Glycemic control would be better due to improvement SMBG and increasing the frequency of insulin injection. Socioeconomic survey showed that some diabetes household income were lower than the average level and diabetic care costs increased family burden.

Key words: type 1 diabetes mellitus, glycemic control, self-monitoring blood glucose(SMBG), insulin injection

中图分类号:

R587.1

吴迪, 巩纯秀, 孟曦, 魏丽亚, 秦淼, 黄书越, 李豫川. 儿童1型糖尿病管理十年前后对比及相关因素分析[J]. 首都医科大学学报, 2013, 34(4): 596-600.

WU Di, GONG Chunxiu, MENG Xi, WEI Liya, QIN Miao, HUANG Shuyue, LI Yuchuan. Comparison of anterior-posterior decade of glycemic control in type 1 diabetic children and adolescents[J]. Journal of Capital Medical University, 2013, 34(4): 596-600.

参考文献

[1] Guariguata L. By the numbers: new estimates from the IDF diabetes atlas update for 2012[J]. Diabetes Res Clin Pract, 2012,98(3):524-525.

[2] Petitti D B, Kingersmith G J, Bell R A, et al. Glycemic control in youth with diabetes: The search for diabetes in youth study[J]. J Pediatr, 2009,155(5):668-672.

[3] Beaufort C E, Lange K, Swift P G F, et al. Metabolic outcomes in young children with type 1 diabetes differ between treatment centers: the Hvidoere Study in young children 2009[J]. Pediatric Diabetes, 2012 Sep 10. doi: 10.1111/j.1399-5448.2012.00922.x.[Epub ahead of print].

[4] DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus[J]. N Engl J Med, 1993,329(14):977-986.

[5] Chuang L M, Tsai S T, Huang B Y, et al. The status of diabetes control in Asia A cross-sectional survey of 24317 patients with diabetes mellitus in 1998[J]. Diabet Med, 2002,19(12):978-985.

[6] Craig M E, Handelsman P, Donaghue K C, et al. Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT[J]. Med J Aust, 2002,177(5):235-238.

[7] Cardwell C R, Patterson C C, Allen M, et al. Diabetes care provision and glycaemic control in Northern Ireland: A UK regional audit[J]. Archives of Disease in Childhood, 2005,90(5):468-473.

[8] Danne T, Mortensen H B, Hougaard P, et al. Persistent differences among centres over 3years in glycaemic control and hypoglycemia in a study of 3805 children and adolescents with type 1 diabetes from the Hvidore Study Group[J]. Diabetes Care, 2001,24(8):1342-1347.

[9] Mortensen H B, Hougaard P. Comparison of metabolic control in a cross-sectional study of 2873 children and aldolescents with IDDM from 18 countries. The Hvidore Study Group on Childhood Diabetes[J]. Diabetes Care, 1997,20(5):714-720.

[10] Scottish Study Group for the Care of the Young Diabetic. Factors influencing glycaemic control in young people with type 1 diabetes in Scotland: A population-based study(DIABAUD2)[J]. Diabetes Care, 2001,24(2):239-244.

[11] Rewers M, Pihoker C, Donaghue K, et al. Assessment and monitoring of glycemic control in children and adolescents with diabetes[J]. Pediatr Diabetes, 2009,10(Suppl 12):71-81.

[12] 巩纯秀,倪桂臣,刘敏等.18岁以下1型糖尿病病人管理状况的评估[J].中国糖尿病杂志,2003,11(3):172-175.

[13] Craig M E, Jones T W, Silink M, et al. Diabetes care, glycemic control,and complications in children with type 1 diabetes from Asia and the Western Pacific Region[J]. J Diabetes and Its Complications, 2007,21(5):280-287.

[14] Rosilio M, Cotton J B, Wieliczko M C, et al. Factors associated with glycaemic control. A cross-sectional nationwide study in 2579 French children with type 1 diabetes. The French Pediatric Diabetes Group[J]. Diabetes Care, 1998,21(7):1146-1153.

[15] Nathan D M, Zinman B, Cleary P A, et al. Mondern-day clinical course of type 1 diabetes mellitus after 30 years' duration: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications and Pittsburgh Epidemiology of Diabetes Complications Experience(1983-2005)[J]. Arch Intern Med, 2009,169(14):1307-1316.

[16] Miller K M, Beck R, Bergenstal R, et al. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1C levels in T1Dexchange clinic registry participants[J]. Diabetes Care, 2013,36(7):2009-2014.

[17] Rausch J, Hood K K, Delamater A, et al. Changes in treatment adherence and glycemic control during the transition to adolescence in type 1 diabetes[J]. Diabetes Care, 2012,35(6):1219-1224.

[18] Gomes M B, Mattos Mateus A S, Calliari L E, et al. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil[J]. Acta Diabetol, 2012,Jun12.[Epub ahead of print](Published online).

[19] Jeff Unger. Comparing the efficacy, safety and utility of intensive insulin algorithms for a primary care practice[J]. Diabetes Ther, 2011,2(1):40-45.