Gill G V
Diabetes Centre, Walton Hospital, Liverpool.
J R Soc Med. 1992 May;85(5):259-61. doi: 10.1177/014107689208500506.
A group of 42 severely brittle insulin dependent diabetic patients were studied, and compared with a similar number of 'stable' diabetic patients. Brittle diabetics were predominantly female (86% v 45%, P < 0.01), were of younger age (mean +/- SD 27.9 +/- 12.8 years v 40.1 +/- 13.6 years, P < 0.001), and of shorter duration of diabetes (13.7 +/- 9.4 years v 19.6 +/- 11.2 years, P < 0.01). Control as measured by glycosylated haemoglobin (HbA1) was poorer (13.7 +/- 3.1% v 10.1 +/- 1.5%, P < 0.001), and daily insulin dose higher (98 +/- 81 u v 47 +/- 14 u, P << 0.001). There was no difference in diabetic complication rates, but psychosocial disturbances (74% v 17%) and factitious instability (40% v 2%) were highly significantly more common amongst brittle patients. Examination of patterns of admission revealed most brittle diabetics to have hyperglycaemic problems (70%), mainly due to recurrent ketoacidosis (52%). Recurrent hypoglycaemia accounted for 12% of the group, and only 5/42 patients (12%) had mixed forms of instability. Brittle diabetes is thus characterized by young age and female sex, and usually manifests itself as recurrent ketoacidosis or other forms of hyperglycaemic instability. Psychosocial problems and factitious metabolic decompensation are common.
对一组42例严重脆性胰岛素依赖型糖尿病患者进行了研究，并与数量相近的“稳定型”糖尿病患者进行了比较。脆性糖尿病患者以女性为主（86%对45%，P<0.01），年龄较小（平均±标准差27.9±12.8岁对40.1±13.6岁，P<0.001），糖尿病病程较短（13.7±9.4年对19.6±11.2年，P<0.01）。通过糖化血红蛋白（HbA1）测量的血糖控制较差（13.7±3.1%对10.1±1.5%，P<0.001），每日胰岛素剂量较高（98±81单位对47±14单位，P<<0.001）。糖尿病并发症发生率没有差异，但脆性患者中社会心理障碍（74%对17%）和人为性血糖不稳定（40%对2%）明显更为常见。对入院模式的检查显示，大多数脆性糖尿病患者存在高血糖问题（70%），主要是由于反复发生的酮症酸中毒（52%）。反复低血糖占该组的12%，只有5/42例患者（12%）有混合型不稳定。因此，脆性糖尿病的特点是年轻和女性，通常表现为反复的酮症酸中毒或其他形式的高血糖不稳定。社会心理问题和人为性代谢失代偿很常见。
