儿童1型糖尿病动态血糖监测的临床意义

Clinical significance of continuous glucose monitoring in children with type 1 diabetes mellitus.

目的应用动态血糖监测系统(CGMS)观察1型糖尿病患儿血糖控制情况,寻找评价和改善血糖控制的方法。方法收集复旦大学附属儿科医院2003年10月至2004年6月内分泌科门诊随访的儿童1型糖尿病患者28例,男16例,女12例,年龄(13.1±4.5)岁,病程(5.5±3.4)年,其中21例采用每天多次胰岛素注射(MDI),另7例使用胰岛素泵连续胰岛素输注(CSII)治疗。动态监测血糖3d,同时指尖血糖监测≥4次/d。结果(1)研究对象体重指数(BMI)为(19.4±3.0)kg/m2,糖化血红蛋白(HbA1c)为(8.4±1.6)%。CSII组HbA1c(8.2±1.0)%,MDI组HbA1c(8.5±1.8)%,差异有显著性意义(P<0.05);(2)CGMS发现22例77次餐后2h高血糖,CSII组4例(57.1%),每例出现1次,MDI组18例(85.7%),每例出现(4.1±2.5)次,差异显著(P<0.01);(3)CGMS发现17例79次低血糖,持续时间(76.6±92.8)min,而指尖血糖监测仅发现19次低血糖;白天低血糖持续时间(41.5±39.1)min,夜间(112.4±117.1)min,夜间低血糖持续时间显著长于白天(P<0.01)。(4)HbA1c≤8%组餐后高血糖发生率低于HbA1c>8%组(P<0.05),而低血糖的发生率显著升高(P<0.01)。结论1型糖尿病患儿多数存在低血糖和餐后高血糖;动态血糖监测系统是发现血糖异常波动的有效工具。动态血糖监测对指导1型糖尿病治疗,调整胰岛素剂量,从而改善血糖控制有着重要的临床意义。

Objective To determine the glycemic control in children with type 1 diabetes mellitus with CGMS. Methods Totally 28 children with type 1 diabetes mellitus [ 16 male and 12 female; mean age（13.13±4.52）years,mean courses of disease （ 5.51 ± 3.43 ） years,7 patients using CSII and 21 using MDI] were enrolled in the study from Oct. 2003 to Jun. 2004. Results Mean HbA1 c （ 8.4 ± 1.6 ） %, MDI group was higher in HbA 1 c than CSII group ; the two groups had significant differences（ P 〈0. 05 ）. Totally 77 high and 79 low glucose patterns were detected with the CGMS and only 19 low glucose patterns with the logbook records. The CGMS detected unrecognized hypoglycemia in 47.1% of the subjects. The duration of hypoglycemia was reported at （76.6 ± 92. $ ） rain, and was significantly longer at nighttime [ （ 112.37 ± 117. 11 ） min ] than in daytime [ （ 41.46 ± 39. 14 ） min ]. Hypoglycemia was more prevalent at night compared with daytime, particularly during 11pm to 7am, accounting for 58. 3% of the total time experienced in hypoglycemia. The prevalence of postprandial hyperglycemia was parallel with the increasing of HbA1c, while that of hypoglycemia had adverse tendency. When hyperglycemia or hypoglycemia occurred, all the children and adolescents were asymptomatic. Conclusion Hypoglycemia and postprandial hyperglycemia are prevalent in children and adolescents with type 1 diabetes mellitus. Continuous glucose monitoring system is a useful tool for detecting hyperglycemia and hypoglycemia.