青岛地区1型糖尿病患儿胰岛素泵长期治疗随访与疗效分析

Long term follow-up and efficacy of continuous subcutaneous insulin infusion in the treatment of children with type 1 diabetes mellitus in Qingdao

目的:探讨胰岛素泵(CSII)在长期治疗1型糖尿病(T1DM)患儿中的疗效,分析影响治疗效果的相关因素,为CSII长期治疗的随访管理提供指导依据。方法:2019年1月至6月对长期在青岛妇女儿童医院内分泌科门诊随访,使用CSII治疗6个月以上,年龄18岁以下,且长期居住于青岛地区的60例T1DM患儿进行问卷调查,了解患儿的一般情况和治疗相关资料。结果:与治疗前相比,T1DM患儿经CSII治疗后糖化血红蛋白(HbA1c)显著下降[(7.12±1.11)%比(9.58±2.08)%],差异有统计学意义( t=7.315, P<0.05);单位体质量每日胰岛素用量减少[0.80(0.66,0.88) IU比0.91(0.86,0.94) IU],差异有统计学意义( Z=-5.514, P<0.05),且CSII治疗后低血糖和酮症酸中毒发生次数均明显改善。饮食控制、每天运动时间、复诊频率、自我血糖监测频率均对CSII治疗效果有影响(均 P<0.05)。 结论:青岛地区T1DM患儿经CSII治疗后可有效控制血糖,明显降低HbA1c,减少胰岛素用量,减少低血糖及酮症酸中毒发生;其中良好的饮食控制、按时运动、规律复诊,尤其是较高频率的血糖监测均有利于血糖控制。

Objective To study the effect of continuous subcutaneous insulin infusion(CSII)in the long-term treatment of type 1 diabetes mellitus(T1DM)children,to analyze the factors influencing the efficacy,and to provide theoretical guidance for the application of CSII in long-term therapy and follow-up management.Method A total of 60 T1DM children who were under 18 years old,lived in Qingdao for a long time,had CSII for more than 6 months,and visited the Outpatient Department of Endocrinology of Qingdao Women and Children′s Hospital for a long term from January 2019 to June 2019 were followed up with questionnaires to understand their general condition and treatment-related data.Result After the CSII therapy,the hemoglobin A1c(HbA1c)of T1DM children significantly decreased from(9.58±2.08)%to(7.12±1.11)%(t=7.315,P<0.05),the daily insulin dosage per unit weight significantly declined from 0.91(0.86,0.94)IU to 0.80(0.66,0.88)IU(Z=-5.514,P<0.05),and the frequency of both hypoglycemia and ketoacidosis was significantly reduced.Diet control,daily exercise time,the visit frequency and the self-monitoring frequency of blood glucose affected the curative effect of CSII therapy(all P<0.05).Conclusion CSII therapy can effectively control the blood glucose of children with T1DM in Qingdao area,significantly lower HbA1c,and reduce the insulin dosage and the incidence of hypoglycemia and ketoacidosis.Good diet control,regular exercise,regular follow-up and a high frequency of blood glucose monitoring are associated with better glycemic control.