1型糖尿病患者胰岛素治疗方案与血糖控制的相关性

Insulin regimes and impact on glycemic control in patients with type 1 diabetes

目的 探讨胰岛素治疗方案与1型糖尿病患者血糖控制之间的关系及影响因素.方法 研究对象来自2011年6月至2014年7月在广东省16个中心开展的广东省1型糖尿病转化医学研究.胰岛素治疗方案分为强化治疗[包括胰岛素泵（R1）、基础胰岛素联合短效或速效胰岛素每日多次治疗（R2）]和非强化治疗（R3）.分析不同治疗方案的比例、糖化血红蛋白水平及达标率,采用logistic回归分析患者选择胰岛素强化治疗的相关因素.结果 共1 421例1型糖尿病患者纳入分析,患者的中位年龄27.8（19.4,38.3）岁,中位病程为3.3（0.5,7.1）年.R1、R2、R3组分别为175例（12.3％）,504例（35.5％）,742例（52.2％）.R1、R2、R3组糖化血红蛋白分别为8.0（6.8,9.3）％、8.9（7.1,11.8）％、9.2（7.5,11.4）％,糖化血红蛋白水平在不同治疗方案之间差异有统计学意义（P ＜0.001）.R1、R2、R3组糖化血红蛋白的总体达标率分别为32.3％、21.1％、17.8％ （P =0.002）.年龄较大（OR=1.01,95％ CI：1.00 ～ 1.02,P=0.027）、家庭人均年收入＞3万元（OR=1.45,95％ CI：1.10～ 1.91,P=0.009）、自身教育程度较高（大学及以上）（OR=1.56,95％CI：1.16～ 2.09,P=0.003）是成人患者选择胰岛素强化治疗的相关因素.结论 广东省1型糖尿病患者的胰岛素治疗方案亟待规范,选择强化治疗的患者糖化血红蛋白达标率高于非强化患者,规范患者治疗方案、加强患者的糖尿病教育可能有助于改善患者的血糖控制.

Objective To describe the insulin regimens and their associations with glycemic control and to explore factors associated with intensive insulin therapy.Methods Patients with type 1 diabetes （T1DM） were recruited from Guangdong Type 1 Diabetes Mellitus Translational Medicine Study which was conducted in 16 centers in Guangdong province.The demographic and clinical data were collected.Patients were grouped according to different insulin regimens：insulin pump （R1）,basal insulin plus regular insulin or short-acting insulin （R2）,insulin injection 1-3 times per day （R3）.Distribution of insulin regimens and the relationships between insulin regimens and hemoglobin A1c （HbA1c） were described.Multivariate logistic regression was used to identify factors associated with intensive insulin therapy.Results A total of 1 421 patients with the age of 27.8 （19.4,38.3） years and a duration of T1DM of 3.3 （0.5,7.1） years were recruited.There was 12.3% of patients in R1 （n =175）,35.5% in R2 （n =504）,and 52.2% in R3 （n =742）,respectively.HbA1c was 8.0 （6.8,9.3）%,8.9 （7.1,11.8）%,and 9.2 （7.5,11.4） % in R1,R2,R3,respectively,and it was associated with insulin regimens （P 〈 0.001）.HbA1c target rate was 32.3%,21.1%,17.8% in R1,R2,R3,respectively （P =0.002）.Older age （OR =1.01,P =0.027）,higher education level （college or above） （OR =1.56,P =0.003）,and higher household income （〉 30 000 yuan per year per person） （OR =1.45,P =0.009） were associated with intensive insulin therapy in adult patients.Conclusions The study suggested that insulin therapy need to be optimized in patients with T1DM.The optimization of insulin regimens and diabetes education may be helpful for improvement of glycemic control.