不同胰岛素注射方式治疗儿童1型糖尿病的临床疗效观察

Observation on clinical efficacy of different insulin injection schemes on type 1 diabetes mellitus in children

目的 观察两种长效胰岛素多次皮下注射与持续胰岛素皮下输注对儿童1型糖尿病的治疗效果。方法 选取85例1型糖尿病患儿作为研究对象,根据治疗方案不同将患儿随机分为多次皮下注射胰岛素(MSII)1组(22例)、MSII 2组(23例)、MSII 3组(21例)及连续皮下注射胰岛素(CSII)组(19例)。MSII 1组给予三餐前门冬胰岛素加睡前1次甘精胰岛素注射, MSII 2组给予三餐前门冬胰岛素加睡前1次地特胰岛素注射, MSII 3组给予三餐前门冬胰岛素加晨起及睡前共2次地特胰岛素注射, CSII组给予胰岛素泵持续泵入胰岛素。治疗3、9个月后,比较四组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、C肽、糖化血红蛋白(HbA1c)、低血糖发生频次及治疗费用。结果 治疗3、9个月后,四组FBG、2 h PG、C肽、HbA1c水平比较差异有统计学意义(P<0.05);CSII组、MSII 1组及MSII 3组FBG、2 h PG、C肽、HbA1c水平优于MSII 2组,差异有统计学意义(P<0.05)。MSII 1组、MSII 3组与CSII组FBG、2 h PG、C肽、HbA1c水平比较差异无统计学意义(P>0.05)。治疗3、9个月后,四组低血糖发生频次比较差异有统计学意义(P<0.05)。治疗3个月后, CSII组、MSII 2组及MSII 3组低血糖发生频次分别为(0.19±0.08)、(0.21±0.08)、(0.22±0.07)次/d,均明显低于MSII 1组(0.28±0.12)次/d,差异有统计学意义(P<0.05)。治疗9个月后, CSII组、MSII 2组及MSII 3组低血糖发生频次分别为(0.18±0.11)、(0.23±0.07)、(0.20±0.09)次/d,均明显低于MSII 1组(0.27±0.10)次/d,差异有统计学意义(P<0.05)。MSII 2组、MSII 3组与CSII组低血糖发生频次比较差异无统计学意义(P>0.05)。治疗9个月后,四组治疗费用比较差异有统计学意义(P<0.05)。CSII组治疗费用(32.56±6.38)元/d明显高于MSII 1组、MSII 2组及MSII 3组的(18.67±4.86)、(19.74±4.29)、(20.06±5.07)元/d,差异有统计学意义(P<0.05)。MSII 1组、MSII 2组与MSII 3组治疗费用比较差异无统计学意义(P>0.05)。结论 对儿童1型糖尿病患儿治疗时应结合血糖控制情况、低血糖发生频次及治疗费用,三餐前门冬胰岛素加晨起及睡前共2次地特胰岛素注射不失为一种胰岛素强化治疗方案的理想选择。

Objective To observe the therapeutic effect of multi subcutaneous injection and continuous subcutaneous infusion(CSII) of two different kinds of long-acting insulin on the treatment of type 1 diabetes mellitus in children. Methods A total of 85 children with type 1 diabetes mellitus were selected for the study and randomly divided into multi subcutaneous insulin injections(MSII) group 1(22 cases), MSII group 2(23 cases),MSII group 3(21 cases) and continuous subcutaneous insulin injections(CSII) group(19 cases) according to different treatment regimens. MSII group 1 was given insulin aspart before meals followed by one-time injection of insulin glargine at bedtime, MSII group 2 was given insulin aspart before meals followed by one-time injection of insulin detemir at bedtime, MSII group 3 was given insulin aspart before meals followed by two-time injection of insulin detemir respectively at bedtime and in the early morning, and CSII group was given insulin pump to continuously pump insulin. After 3 and 9 months of treatment, fasting blood glucose(FBG), postprandial 2 h blood glucose(2 h PG), C-peptide, glycosylated hemoglobin(HbA1c), frequency of hypoglycemia and treatment cost were compared among the four groups. Results After 3 and 9 months of treatment, there was a statistically significant difference among the four groups in terms of FBG, 2 h PG, C-peptide, HbA1c levels(P<0.05). The FBG, 2 h PG, C-peptide, HbA1c levels in CSII group, MSII group 1 and MSII group 3 was better than that in MSII group 2, and the difference was statistically significant(P<0.05). There was no statistically significant difference in terms of FBG, 2 h PG, C-peptide, HbA1c levels among MSII group 1, MSII group 3 and CSII group(P>0.05). After 3 and 9 months of treatment, the difference in the frequency of hypoglycemia in the four groups was statistically significant(P<0.05). After 3 months of treatment, the frequency of hypoglycemia were(0.19±0.08),(0.21±0.08) and(0.22±0.07) times/d in the CSII group, MSII group 2 and MSII group 3, which were significantly lower than(0.28±0.12) times/d in the MSII group 1, and the difference was statistically significant(P<0.05). After 9 months of treatment, the frequency of hypoglycemia were(0.18±0.11),(0.23±0.07) and(0.20±0.09) times/d in CSII group, MSII group 2 and MSII group 3, which were significantly lower than(0.27±0.10) times/d in MSII group 1, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the frequency of hypoglycemia among MSII group 2, MSII group 3 and CSII group(P>0.05). After 9 months of treatment, the treatment cost was compared in the four groups, and the difference was statistically significant(P<0.05). The treatment cost of CSII group was(32.56±6.38) yuan/d, which was significantly higher than(18.67±4.86),(19.74±4.29) and(20.06±5.07) yuan/d of MSII group 1, MSII group 2 and MSII group 3, and the difference was statistically significant(P<0.05). There was no statistically significant difference in treatment cost among MSII group 1, MSII group 2 and MSII group 3(P>0.05). Conclusion For children with type 1 diabetes mellitus, considering the hyperglycemia control, frequency of hypoglycemia and the treatment cost, the injection of insulin aspart before meals followed by two-time injection of insulin detemir respectively at bedtime and in the early morning is an ideal choice for intensive insulin therapy.