浙江省1型糖尿病住院患者临床特征及管理现状调查

Survey on clinical characteristics and management status of hospitalized patients with type 1 diabetes mellitus in Zhejiang province

目的:探讨浙江省1型糖尿病(T1DM)住院患者的临床特征及管理现状。方法:为横断面研究。选择2016年10月至2022年7月于浙江省10家医院住院的T1DM患者作为研究对象。收集患者的一般临床资料(包括起病年龄、性别、住院天数、病程)、实验室指标[包括生化、糖化血红蛋白、餐后2 h血糖、胰岛素、C肽、谷氨酸脱羧酶抗体(GADA)、蛋白酪氨酸磷酸酶抗体(IA-2A)、胰岛素自身抗体(IAA)、胰岛细胞抗体(ICA)]、并发症筛查情况(包括尿白蛋白/肌酐比值检测、眼底照相、肌电图、颈动脉超声、双下肢动脉超声及四肢多普勒超声)、治疗方案(包括胰岛素治疗方案及联用降糖药的情况)等。按照就诊时间将T1DM患者分为2016年10月至2019年8月组及2019年9月至2022年7月组,比较两组慢性并发症筛查率、检出率及抗体检测率等情况。组间比较采用 χ2检验。 结果:共564例T1DM患者纳入本研究。患者的年龄从1岁到84岁不等,其中成人(≥18岁)390例,儿童和青少年(<18岁)174例。T1DM患者的住院天数、起病年龄和病程中位数分别为7(6,10)d、29(16,45)岁和3(0,8)年。其中,56.6%(319/564)的T1DM患者有急性并发症,49.6%(280/564)的T1DM患者有慢性并发症。56.9%(321/564)的T1DM患者有合并症,包括血脂异常[25.7%(145/564)]、高血压[12.2%(69/564)]、高尿酸血症[8.2%(46/564)]、自身免疫性甲状腺疾病[9.0%(51/564)]、肥胖症[4.8%(27/564)]。糖尿病肾脏病、糖尿病视网膜病变、糖尿病周围神经病变及糖尿病周围血管病变的筛查率分别为71.5%(403/564)、58.9%(332/564)、55.5%(313/564)及80.7%(455/564),相应的检出率分别为21.6%(87/403)、27.4%(91/332)、47.0%(147/313)和31.6%(144/455)。99.5%(561/564)的T1DM患者使用胰岛素治疗。每日多次胰岛素注射治疗占比最高,为78.7%(444/564)。除胰岛素外,34.0%(192/564)的T1DM患者还联用非胰岛素类药物,α-葡萄糖苷酶抑制剂是最常用的药物[53.6%(103/192)]。2019年9月至2022年7月组GADA、IA-2A、ICA、IAA检测率高于2016年10月至2019年8月组( P<0.05)。并发症筛查中,除糖尿病肾脏病外,2019年9月至2022年7月组患者慢性并发症筛查率均比2016年10月至2019年8月组高,包括视网膜病变、周围神经病变、周围血管病变筛查率均提高( P<0.05)。 结论:浙江省T1DM患者主要是成人起病。近年来,浙江省T1DM患者的糖尿病并发症筛查率及抗体检测率呈上升趋势,体现了浙江省对T1DM住院患者的管理较前更加规范,但糖尿病抗体检测率及并发症的筛查率仍较低,有待进一步提高。

ObjectiveTo investigate the clinical characteristics and current management of hospitalized patients with type 1 diabetes mellitus(T1DM)in Zhejiang province.MethodsA cross-sectional study of T1DM patients hospitalized in 10 hospitals in Zhejiang province from October 2016 to July 2022 to collect general clinical data(age at onset,sex,number of days in hospital,duration of illness),laboratory indicators[biochemistry,glycated hemoglobin A 1c,2-hour postprandial glucose,insulin,C-peptide,glutamic acid decarboxylase antibody(GADA),protein tyrosinephosphatase antibody(IA-2A),islet cell antibody(ICA),insulin autoantibody(IAA)],screening for complications(urine albumin/creatinine ratio,fundus photography,electromyography,carotid ultrasound,bilateral lower extremity arterial ultrasound and extremity Doppler ultrasound screening),and treatment protocols(insulin regimens and co-administration of hypoglycemic agents).The two groups were divided into October 2016 to August 2019 group and September 2019 to July 2022 group according to the time of visit,and the screening rate,detection rate and antibody detection rate of chronic complications management were compared between the two groups.The χ^(2) test was used to compare between groups.ResultsA total of 564 patients with T1DM aged from 1 to 84 years were enrolled,including 390 adults(≥18 years)and 174 children and adolescents(<18 years).The mean days of hospitalization,age of onset and duration of T1DM were 7(6,10)days,29(16,45)years and 3(0,8)years,respectively.Of these,319 patients(56.6%)with T1DM had acute complications and 280 patients(49.6%)had chronic complications.More than half of the patients[56.9%(321/564)]had comorbidities,including dyslipidemia[25.7%(145/564)],hypertension[12.2%(69/564)],hyperuricemia[8.2%(46/564)],autoimmune thyroid disease[9.0%(51/564)],and obesity[4.8%(27/564)].The screening rates for diabetic nephropathy,diabetic retinopathy,diabetic neuropathy,and diabetic vasculopathy were 71.5%(403/564),58.9%(332/403),55.5%(313/564),and 80.7%(455/564),respectively,with corresponding detection rates of 21.6%(87/403),27.4%(91/332),47.0%(147/313)and 31.6%(144/455).Screening rates for chronic complications and the detection of diabetes antibodies have increased in recent years.The majority of T1DM patients[99.5%(561/564)]used insulin therapy.The most commonly used therapy was multiple daily insulin injections[78.7%(444/564)].In addition to insulin,192(34.0%)patients with T1DM used non-insulin drugs in combination.Glucosidase inhibitors were the most commonly used drugs[53.6%(103/192)].The detection rates of GADA,IA-2A,ICA and IAA in September 2019 to July 2022 group were higher than those in October 2016 to August 2019 group(P<0.05).In the screening of complications,except for diabetic kidney disease,the screening rate of chronic complications in September 2019 to July 2022 group was higher than that in October 2016 to August 2019 group,and the screening rate of retinopathy,peripheral neuropathy and peripheral vascular disease was significantly increased(P<0.05).ConclusionsPatients with T1DM in Zhejiang province are mainly adult-onset.In recent years,the screening rate of diabetic complications and antibody detection rate of T1DM patients in Zhejiang province have increased,reflecting that the management of T1DM hospitalized patients in Zhejiang province is more standardized than before,but the diabetic antibody detection rate and the screening rate of complications are still low and need to be further improved.