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目的观察应用基础加餐时胰岛素治疗儿童1型糖尿病(T1DM)的临床效果。方法 15例T1DM患儿采用传统治疗方案治疗平均16个月:双时相低精蛋白锌胰岛素30/70,2/3量早餐前30 min皮下注射,1/3量晚餐前30 min皮下注射;之后采用基础加餐时治疗方案治疗至少12个月:3餐前0~15 min门冬胰岛素皮下注射,睡前甘精胰岛素皮下注射。观察基础加餐时方案治疗后糖化血红蛋白(HbA1c)水平、胰岛素用量和低血糖发生情况。结果 15例T1DM患儿应用基础加餐时胰岛素类似物治疗后3、6、9、12个月的HbA1c与传统治疗相比降低(t=7.15、4.88、3.46、5.28,Pa<0.01),3、6、9、12个月的HbA1c相互间比较差异无统计学意义(t=2.08、1.64、1.73、1.85、1.96、1.66,Pa>0.05)。胰岛素用量差异无统计学意义(t=1.56,P>0.05)。传统方法治疗期间,7例发生严重低血糖,改用基础加餐时胰岛素治疗方案后,无一例发生严重低血糖。发生轻中度低血糖的次数亦显著减少(t=13.31,P<0.001)。结论应用基础加餐时胰岛素治疗儿童T1DM可使患儿获得较好的血糖控制,同时减少低血糖发生,而胰岛素用量并无增加,并可改善患儿的治疗满意度及生活质量。
Objective To observe the clinical effect of insulin therapy on children with type 1 diabetes mellitus (T1DM). Methods A total of 15 children with T1DM were treated with the traditional treatment regimen for an average of 16 months. Subcutaneous injection of 30/70 and 2/3 of the two phases of hypophile zinc insulin 30 min before breakfast and 1/3 of the subcutaneous injection 30 min before dinner. After the treatment of basic mealtime treatment at least 12 months: 3 meals before 0 ~ 15min aspart insulin subcutaneous injection of insulin glargine before bedtime subcutaneous injection. Observe the level of glycosylated hemoglobin (HbA1c), insulin dosage and incidence of hypoglycemia after basic meal treatment. Results HbA1c in 15 T1DM children at 3, 6, 9 and 12 months after treatment with insulin analogs decreased (t = 7.15, 4.88, 3.46, 5.28, P <0.01) There was no significant difference in HbA1c at 6, 9 and 12 months (t = 2.08,1.64,1.73,1.85,1.96,1.66, Pa> 0.05). There was no significant difference in insulin dosage (t = 1.56, P> 0.05). During the traditional treatment, no severe hypoglycemia occurred in 7 patients who developed severe hypoglycemia and switched to insulin therapy based on mealtime. The number of mild to moderate hypoglycemia was also significantly reduced (t = 13.31, P <0.001). Conclusion The application of basic insulin therapy in children with T1DM can achieve better glycemic control and reduce the incidence of hypoglycemia in children with no increase of insulin dosage, and can improve the treatment satisfaction and quality of life in children.