住院1型糖尿病患儿低血糖发生现状及影响因素研究

Study of the occurrence and influencing factors of hypoglycemia in hospitalized children with type 1 diabetes mellitus

目的分析住院1型糖尿病(T1DM)患儿低血糖发生现状并探讨其影响因素。方法回顾性收集2016年1月1日至2022年1月1日在重庆医科大学附属儿童医院住院T1DM患儿的病历资料,包括年龄、性别、照护者文化程度、病程、胰岛素注射方案、入院有无酮症酸中毒、糖化血红蛋白、有无合并症、住院天数等指标。将住院期间有一次及以上血糖<3.9 mmol/L的T1DM患儿纳入低血糖组,其余纳入无低血糖组。分析低血糖发生的特点,组间比较采用独立样本t检验、χ^(2)检验、Mann-Whitney U检验。采用二分类logistic回归分析法分析低血糖的影响因素。结果本研究共纳入854例T1DM患儿,其中男414例、女440例,年龄(7.41±3.89)岁。住院期间血糖监测总次数为69553次,低血糖发生3863次,发生密度为5.55%(3863/69553),其中1级低血糖占4.07%(2828/69553),2级低血糖占1.49%(1035/69553)。有80.21%(685/854)的患儿在住院期间发生过至少1次低血糖,其中发生单次低血糖的患儿占16.51%(141/854),2次以上占63.70%(544/854)。在发生的低血糖中,以夜间0:00—6:00低血糖发生率最高。多因素logistic回归分析显示:年龄0~6岁(OR=5.116,95%CI 2.732~9.580,P<0.001),治疗方案为每日多次皮下注射方案(OR=1.997,95%CI 1.212~3.290,P=0.007)和每日多次皮下注射方案+持续皮下胰岛素输注(OR=2.192,95%CI 1.137~4.228,P=0.019),住院天数(OR=1.125,95%CI 1.173~1.332,P<0.001)均是低血糖发生的影响因素。结论住院T1DM患儿低血糖发生率为80.21%。低血糖的发生与年龄、初次诊断、胰岛素注射方式、日均胰岛素剂量、住院天数有关。

Objective To analyze the prevalence of hypoglycemia in hospitalized children with type 1 diabetes mellitus(T1DM)and to explore its influencing factors.Methods The medical records of children with T1DM hospitalized at the Affiliated Children′s Hospital of Chongqing Medical University from January 1,2016 to January 1,2022 were retrospectively collected,including age,sex,education level of caregivers,disease course,insulin injection regimen,ketoacidosis,glycosylated hemoglobin,complications,hospitalization days,etc.The children with one or more blood glucose<3.9 mmol/L during hospitalization were divided into hypoglycemia group and non-hypoglycemia group.The characteristics of hypoglycemia were analyzed.Independent sample t test,χ^(2) test,Mann-Whitney U test and binary logistic regression analysis were used to analyze the influencing factors of hypoglycemia,and the stepwise method was used to screen variables.Results A total of 854 children with T1DM were included in this study,including 414 boys and 440 girls with an average age of(7.41±3.89)years.The total number of blood glucose monitoring during hospitalization that met the inclusion criteria was 69553 times,hypoglycemia occurred 3863 times,and the occurrence density was 5.55%(3863/69553).Of these,grade 1 hypoglycemia accounted for 4.07%(2828/69553),whereas grade 2 hypoglycemia accounted for 1.49%(1035/69553).80.21%(685/854)of the children had hypoglycemia at least once during hospitalization,with 16.51%(141/854)having a single hypoglycemia and 63.70%(544/854)having it more than twice.In terms of the occurrence of hypoglycemia,the prevalence of hypoglycemia was the highest at night.Multivariate logistic regression analysis showed that the age was 0-6 years old(OR=5.116,95%CI 2.732-9.580,P<0.001),the treatment regimen was multiple daily subcutaneous injection(OR=1.997,95%CI 1.212-3.290,P=0.007)and multiple daily subcutaneous injection plus continuous subcutaneous insulin infusion(OR=2.192,95%CI 1.137-4.228,P=0.019),and the length of hospital stay(OR=1.125,95%CI 1.173-1.332,P<0.001)are the influencing factors of hypoglycemia.Conclusions The prevalence of hypoglycemia in hospitalized children with T1DM is 80.21%,and the current situation needs to be improved.The occurrence of hypoglycemia is associated with age,initial diagnosis,mode of insulin injection,average daily insulin dose and hospitalization days.