18岁以下1型糖尿病病人管理状况的评估

The assessment of management for 1 diabetes mellitus children

目的 了解和评估北京地区儿童青少年 1型糖尿病病人的控制和管理情况。 方法 北京儿童医院进行管理的 18岁以下的病程 1年以上 1型糖尿病病人 12 3例。采用国际糖尿病联盟儿童青少年糖尿病协会统一问卷和标准采血测量HbA1 c。 结果 该组 1型糖尿病病人控制状况并不满意 ,平均HbA1 c为 9.8%,在亚太地区排为中下水平 ,管理方法需要改进。病程长短不是糖尿病控制好坏的决定因素 ;学龄前发病的病人易于管理 ,青春期较差 ;女性较难控制。血糖自我检测次数少 ,每月约 2次 ;胰岛素注射次数 92 %以上为每日注射 2次 ,明显少于西太地区 (WPR)平均水平。胰岛素用量不足 ( 0 .77± 0 2 5U·kg- 1 ·d- 1 ) ,与控制水平呈正相关。 结论 血糖自我检测少 ,胰岛素用量不足是糖尿病控制不良的主要因素。增加血糖自我监测次数和及时、足量的胰岛素治疗是改善糖尿病控制的主要方面。学龄前发病的病人依从性好 ,糖尿病得到了满意的控制 ,说明对糖尿病病人的管理比疾病本身对胰岛素的依赖更重要。

Objective Beijing Children's Hospital took part in the assessment of Diabcare of IDF-WPR 2001 (international diabetes federation -west pacific region 2001), a benchmarking survey and analysis of the successful and unsuccessful factors. Methods 123 type 1 diabetic children were registered in our hospital for management of diabetes for more than 12 months. Pediatricians fulfilled a standard ISPAD form for each subject. HbA 1c of patients were determined by automatic high-pressure liquid chromatography in an appointed center laboratory (PLA 301 Hospital). And patients were subdivided into 3 groups by HbA 1c levels according to the Consensus Guideline 2000. Affecting factors analysis included chi-squire, fisher test, avon test, t test and regression analysis. Results The average HbA 1c level of the patients was 9.8%, showing a poor control. Duration of diabetes was not the important affecting factor for glucose control. Diabetic children at pre-school onset got better control. Female got worse control than male, P=0.031. And there was no significant difference (t=0.442,P=0.656) when the insulin dose was compared between male and female (insulin dose 0.78±0.25 U/kg/day in male v.s. 0.76±0.24 U/kg/day in female). Self-monitor of blood glucose was only twice a month. This was less than the average level of WPR data. The average insulin dose of these patients was 0.77 U/kg/day, being less than the average dose of WPR. The proportion of injection twice a day was as high as 92%. Conclusion Among all the controllable factors, the main affecting factors in this group patient are insufficiency in insulin treatment and short of BG self-monitor. Sex is an independent affecting factor on diabetes control. Management is very important for the glucose control of diabetic children. Our data prove that patients at preschool onset who have special care get a better control.