胰岛素治疗小儿糖尿病的效果及血糖指标分析

Analysis of the effect of insulin on the treatment of infantile diabetes and blood glucose index

目的探讨胰岛素治疗小儿1型糖尿病(T1DM)是的效果及血糖指标分析。方法选取该院在2019年3月—2020年3月确诊并治疗的66例T1DM患儿,采用随机数字表法分组,对照组应用每日多次皮下胰岛素注射(MDI)治疗,研究组使用胰岛素泵持续皮下胰岛素输注(CSII)治疗。观察比较两组的血糖控制指标情况;两组随访3个月、6个月的HbA1c水平及差异;两组治疗前、治疗后的相关生存质量(PedsQL)量表指标水平及差异;两组发生低血糖的情况。结果研究组治疗后的HbA1c水平为(8.4±1.3)%,比对照组治疗后的HbA1c水平(9.8±2.3)%显著更低,差异有统计学意义(t=18.694,P<0.05);研究组血糖达标耗时为(4.3±2.4)d,比对照组的血糖达标耗时(6.8±2.1)d更短,差异有统计学意义(t=16.457,P<0.05)。研究组随访3个月、6个月的HbA1c水平分别为(8.3±1.4)%、(8.1±1.4)%,比对照组随访3个月、6个月的HbA1c水平(9.7±2.2)%、(8.9±2.4)%显著更低,差异有统计学意义(t=17.452、18.021,P<0.05)。研究组治疗后患儿的各项生存质量指标评分分别为症状(28.4±2.5)分、治疗障碍(10.2±1.2)分、依从性(9.5±1.4)分、担忧(8.3±1.4)分、交流(6.2±2.1)分、总分(60.3±3.3)分,比对照组患儿的各项生存质量指标评分:症状(31.4±3.2)分、治疗障碍(13.1±2.1)分、依从性(11.1±1.6)分、担忧(10.5±1.7)分、交流(7.9±2.1)分、总分(75.2±5.9)分显著更低,差异有统计学意义(t=16.582、17.635、16.152、19.845、17.032、17.984,P<0.05)。研究组治疗后患儿父母的各项生存质量指标评分分别为体力(18.2±2.6)分、情绪(8.2±2.3)分、社会(10.1±1.6)分、学校(9.8±1.8)分、治疗(10.2±2.1)分、总分(56.9±2.2)分,比对照组患儿父母的各项生存质量指标评分:体力(21.2±3.2)分、情绪(10.9±3.5)分、社会(12.7±2.3)分、学校(12.2±2.1)分、治疗(12.5±2.6)分、总分(68.5±2.6)分显著更低,差异有统计学意义(t=8.152、19.032、17.452、19.021、17.452、19.354,P<0.05)。研究组发生低血糖比率水平(3.0%),比对照组的发生低血糖比率(24.2%)更低,差异有统计学意义(χ^(2)=4.632,P<0.05)。结论给予T1DM患儿使用CSII治疗,可以显著缩短血糖达标时间、降低HbA1c水平,且可以更有效地提高T1DM患儿的生活质量水平,治疗过程中低血糖的发生风险及比率较低。

Objective To investigate the effect of insulin in treating children with type 1 diabetes(T1 DM) and analysis of blood glucose indicators. Methods A total of 66 children with T1 DM who were diagnosed and treated in the hospital from March 2019 to March 2020 were selected and according to the randomly number table method divided into groups. The control group was treated with multiple subcutaneous insulin injections(MDI) every day.The study group was treated with continuous subcutaneous insulin infusion(CSII) with an insulin pump. Observed and compared the blood glucose control indicators of the two groups. The HbA1c levels and differences between the two groups were followed up for 3 months and 6 months. The levels and differences of related quality of life(PedsQL) scale indicators before and after treatment, hypoglycemia occurred in the two groups were observed and compared. Results The level of HbA1c in the study group was(8.4±1.3) % after treatment, which was lower than that in the control group(9.8±2.3) % after treatment, and the difference was statistically significant(t=18.694, P<0.05). The time of blood glucose reaching standard in the study group was(4.3±2.4) d, which was shorter than that in the control group(6.8±2.1) d, and the difference was statistically significant(t=16.457, P<0.05). The HbA1 c levels of the study group were(8.3±1.4) % and(8.1±1.4) % at 3 and 6 months follow-up respectively, which were lower than the HbA1 c levels of the control group(9.7±2.2) % and(8.9±2.4) % at 3 and 6 months follow-up respectively, and the difference was statistically significant(t=17.452, 18.021, P<0.05). The quality of life index scores of the children in the study group after treatment were as follows: symptoms(28.4±2.5) points, treatment barriers(10.2±1.2) points,compliance(9.5 ±1.4) points, worry(8.3 ±1.4) points, communication(6.2 ±2.1) points, total score(60.3 ±3.3) points,compared with the control group of children’s quality of life index scores: symptom(31.4 ±3.2)points, treatment barrier(13.1 ±2.1)points, compliance(11.1 ±1.6)points, worry(10.5 ±1.7)points, communication(7.9 ±2.1)points and total score(75.2±5.9)points were significantly lower, the difference was statistically significant(t=16.582, 17.635,16.152, 19.845, 17.032, 17.984, P<0.05). The scores of various quality of life indexes of the parents of the children in the study group after treatment were: physical strength(18.2±2.6) points, emotional(8.2±2.3) points, social(10.1±1.6) points, school(9.8±1.8) points, treatment(10.2±2.1) points, total score(56.9±2.2) points, compared with the control group’s physical strength(21.2±3.2)points, emotional(10.9±3.5)points, social(12.7±2.3)points, school(12.2±2.1)points, treatment(12.5±2.6)points and total(68.5±2.6)points scores were significantly lower, the difference was statistically significant(t=8.152, 19.032, 17.452, 19.021, 17.452, 19.354, P<0.05). The rate of hypoglycemia in the study group(3.0%) was lower than that in the control group(24.2%), and the difference was statistically significant(χ^(2)=4.632, P <0.05). Conclusion The CSII treatment for children with T1DM can significantly shorten the time for blood glucose to reach the target, reduce the level of HbA1c, and can more effectively improve the quality of life of children with T1DM. The risk and rate of hypoglycemia during treatment are lower.