对儿童青少年1型糖尿病代谢控制状况的再评估

Reassessment of the control state for type 1 diabetes mellitus in children and adolescents

目的了解管理方法改进后的T1DM控制状况。方法我院进行管理的18岁以下、病程1年以上的T1DM病人102例,年龄平均13岁。比较管理方法改进前后的血糖控制情况。结果与改进前比本次调查A1c均数为9·1%,较前的9·8%明显下降(P<0·01)。年龄小者及男孩控制更好。控制很差组的病程长、胰岛素用量大、血糖监测次数和注射次数少。结论管理改进后代谢控制水平总体好转。大年龄及女孩仍是控制差的因素之一。血糖监测次数对代谢控制起到非常重要的自我约束作用。必要时应采取更符合生理节律的胰岛素多次注射或泵治疗。

Objective To reassess the control state for T1DM by the benchmarking survey of year 2001-2002. Methods The 102 diabetic children at age of〈18 years including 46 boys and 56 girls with average of 13 years were＇registered in our hospital for diabetes management for more than one year. Pediatricians fulfilled a standard form for each subject. Improved managements included training medical providers with new theory,educating patients, obligating BG monitoring and intensive treatment on time. Patients were subdivided into 3 groups by HbA1 c levels according to the 《consensus guideline 2000》. Results The average HbA1c level of patients was 9.12%, much better than the benchmarking 9, 8%, P〈 0.01. The optimal rate was much higher than before （22.50% vs 11.38% ）, the high risk rate decreased （49.0% vs 64.23%）. Age and sex effected the BG control. Young diabetic children got better control. There were more girls and more long standing diabetic children in high risk group. They had more insulin dosage, less injections and less BG monitoring per day. Conclusion The average control is better after the inproving of management. Age increment and female are some of the factors for poor control. BG self-monitoring makes them self-restriction. Updating the knowledge of diabetic management for medical providers and applying new instruments such as CSII should be run when necessary.