地特胰岛素治疗儿童和青少年1型糖尿病的疗效观察

Primary observation of insulin detemir therapy in children and adolescents with type 1 diabetes mellitus

目的 观察应用地特胰岛素治疗儿童和青少年1型糖尿病（T1DM）的临床效果.方法 30例T1 DM患者分为2组,观察组（15例）采用优泌林R加地特胰岛素的治疗方案,对照组（15例）采用优泌林R加中性鱼精蛋白锌人胰岛素的治疗方案,观察2组治疗后胰岛素用量、血糖变异和低血糖发生情况.结果 观察组、对照组每日胰岛素总量分别为（1.16±0.30） U/kg和（1.21 ±0.35） U/kg,差异无统计学意义（t=0.526,P＞0.05）.个体内空腹血糖变异系数观察组为29％,明显低于对照组的65％,2组比较差异有统计学意义（t=5.296,P＜0.01）.观察组发生1例次严重低血糖事件,对照组共发生5例次严重低血糖事件,2组比较差异有统计学意义（t=4.863,P＜0.01）;夜间（22：00-7：00）低血糖事件观察组发生2例次,对照组7例次,2组比较差异有统计学意义（t=4.506,P＜0.01）.结论 用地特胰岛素治疗儿童及青少年T1 DM可使个体空腹血糖变异小,同时可减少严重及夜间低血糖的发生,而胰岛素用量并无增加,是儿童及青少年T1DM患者治疗的方法.

Objective To observe the clinical effect by using insulin detemir therapy in children and adolescents with type 1 diabetes mellitus（T1DM）.Methods Thirty children and adolescents with T1DM were divided into 2 groups to receive Humulin R and Determir（observation group,n =15） or Humulin R and neutral protamine hagedorn （NPH） （control group,n =15）insulin therapy.Daily insulin dose,glycemic variability,incidence of non-severe and severe hypoglycemia events after the institution of insulin therapy were collected.Results The daily doses of insulin were （1.16 ± 0.30） U/kg in the observation group and（1.21 ± 0.35） U/kg in the control group,respectively.There was no clinically important change between 2 groups（t =0.526,P 〉 0.05）.Within-subject variation in fasting plasma glucose was significantly lower in observation group（29%）than that in control group（65%） （t =5.296,P 〈0.01）.One case of severe hypoglycemia event occurred in the observation group,but 5 cases occurred in the control group（t =4.863,P 〈 0.0l）.Two cases of nocturnal hypoglycaemia（22：00-7：00） events occurred in the observation group,7 cases occurred in the control group（t =4.506,P 〈 0.01）.Conclusions Institution of insulin detemir therapy is associated with low within-subject variation in fasting plasma glucose and decreased rates of severe and nocturnal hypoglycemia while dose of insulin did not increase.This makes insulin detemir a valuable new tool for the treatment of children and adolescents with T1 DM.