Alemzadeh Ramin, Loppnow Cindy, Parton Elaine, Kirby Midge
Department of Pediatrics, MACC Fund Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Diabetes Technol Ther. 2003;5(2):167-73. doi: 10.1089/152091503321827821.
Maintaining blood glucose (BG) levels within the target range can be an elusive goal in children with type 1 diabetes mellitus (DM). To identify factor(s) that may contribute to glycemic instability, we analyzed the Continuous Glucose Monitoring System (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 DM and a history of frequent BG fluctuations and hypoglycemia. A total of 30 (17 girls, 13 boys) pediatric patients with a history of frequent BG fluctuations and hypoglycemia (mean age, 10.5 +/- 0.7 years; duration, 5.0 +/- 0.6 years), on three to four injections of insulin daily or insulin pump therapy, were evaluated by the CGMS. The mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated in each patient. There was a significant correlation between MBG and glycosylated hemoglobin (HbA1c) (r(2) = 0.22, p < 0.009). There was also a significant correlation between severity of lipohypertrophy and glycemic control (HbA1c) (r(2) = 0.20, p < 0.01). The MODD values had a positive correlation with the severity of injection site lipohypertrophy (r(2) = 0.37, p < 0.0003). The MAGE values had a positive correlation with bolus:basal insulin ratio (r(2) = 0.22, p < 0.009) and number of hypoglycemic events (r(2) = 0.21, p < 0.008), independent of age, MBG, and glycemic control. The 48-h CGMS profile can help characterize day-to-day and within-day BG variability and identify factors influencing glycemic instability in pediatric type 1 DM.
对于1型糖尿病（DM）患儿而言，将血糖（BG）水平维持在目标范围内可能是一个难以实现的目标。为了确定可能导致血糖不稳定的因素，我们分析了一组有1型DM且有频繁BG波动和低血糖病史的儿童的连续血糖监测系统（CGMS）（美敦力MiniMed，加利福尼亚州北岭）数据。共有30名（17名女孩，13名男孩）有频繁BG波动和低血糖病史的儿科患者（平均年龄10.5±0.7岁；病程5.0±0.6年），接受每日三到四次胰岛素注射或胰岛素泵治疗，通过CGMS进行评估。计算了每位患者48小时的平均BG（MBG）、每日差异绝对值（MODD）、血糖波动幅度平均值（MAGE）以及低血糖事件数量（BG<60mg/dL）。MBG与糖化血红蛋白（HbA1c）之间存在显著相关性（r² = 0.22，p<0.009）。脂肪增生严重程度与血糖控制（HbA1c）之间也存在显著相关性（r² = 0.20，p<0.01）。MODD值与注射部位脂肪增生严重程度呈正相关（r² = 0.37，p<0.0003）。MAGE值与大剂量胰岛素：基础胰岛素比值（r² = 0.22，p<0.009）以及低血糖事件数量（r² = 0.21，p<0.008）呈正相关，且不受年龄、MBG和血糖控制的影响。48小时的CGMS数据有助于描述每日和日内BG变异性，并识别影响1型DM患儿血糖不稳定的因素。
