地特胰岛素注射液联合短效胰岛素治疗学龄期儿童1型糖尿病疗效分析

Insulin Detemir Injection Combined with Short-Acting Insulin in the Treatment of School-Age Children with Type 1 Diabetes Mellitus

目的:观察地特胰岛素注射液联合短效胰岛素治疗学龄期儿童1型糖尿病(T1DM)的临床疗效,为临床提供参考。方法:选取2012年1月至2017年1月在郑州儿童医院内分泌遗传代谢科初诊住院、血糖控制稳定后出院门诊长期随访的学龄期T1DM患儿64例,按治疗方案分为观察组和对照组各32例。观察组应用睡前地特胰岛素注射液联合三餐前短效胰岛素,对照组采用传统治疗方案睡前中效胰岛素联合三餐前短效胰岛素治疗。观察两组患儿糖化血红蛋白、晨起空腹血糖、C肽、胰岛素用量及低血糖、糖尿病酮症酸中毒发生情况。结果:出院治疗3个月、6个月时,观察组糖化血红蛋白均低于对照组(P均<0.05);两组C肽、晨起空腹血糖、胰岛素用量比较差异均无统计学意义(P均>0.05)。出院6个月内,观察组发生非严重低血糖12例次,对照组发生62例次(χ2=7.14,P<0.05)。两组均无严重低血糖、糖尿病酮症酸中毒发生。结论:地特胰岛素注射液能够较好地控制学龄期T1DM患儿的血糖,减少非严重低血糖发生率,且不增加胰岛素用量,值得临床推广应用。

Objective： To observe the clinical efficacy of insulin detemir injection combined with short-acting insulin in the treatment of school-age children with type 1 diabetes mellitus （T1DM）, so as to provide reference for the clinic. Methods： After the stability of blood glucose control, a long term following-up 64 school-age children with T1DM were extracted from endocrinology and metabolism department from Jan. 2012 to Jan. 2017, these children were divided into observation group and control group according to different treatment regimen, with 32 cases in each. The observation group received insulin detemir injection before bedtime combined with short- acting insulin before meals, while the control group was given traditional treatment regimen of short-acting insulin before meals combined with moderate-acting insulin before bedtime. The glycated hemoglobin, morning fasting blood glucose, c-peptide, insulin dosage and hypoglycemia incidence of diabetic ketoacidosis of two groups were observed. Results： After discharge therapy of 3, 6 months, the glycated hemoglobin of observation group was lower than that of control group （ P〈0. 05 ） ; there was no statistically significant difference between two groups in c-peptide, morning fasting blood glucose and insulin dosage （P〉0.05）. Within the discharge therapy of 6 months, non-severe hypoglycemia was found in 12 cases in observation group, and 62 cases in control group （χ2 = 7.14, P〈0.05）. There was no severe hypoglycemia and diabetic ketoacidosis occurred in both groups, Conclusion： Insulin detemir injection can control the blood sugar of school-age children with T1DM, and reduce the incidence of non-severe hypoglycemia without increasing the insulin dose, which is worthy of clinical application