Kamoi Kyuzi, Tanaka Midori, Ikarashi Tomoo, Miyakoshi Masashi
The Diabetes and Endocrine and Metabolism Disease Center, Nagaoka Red Cross Hospital, 297-1 Terajima-machi, Nagaoka, Niigata 940-2085, Japan.
Diabetes Res Clin Pract. 2006 Nov;74(2):141-7. doi: 10.1016/j.diabres.2006.03.028. Epub 2006 May 24.
At 5:56 p.m. on October 23, 2004, a major earthquake of magnitude 6.8 on the Richter scale struck the Chuetsu district of Niigata Prefecture, Japan, a rural area with mountain villages. Strong aftershocks of grade 5-6 on the Japanese Intensity Scale continued for 2 months. We investigated changes in the HbA1c levels of 65 type 1 diabetic patients with insulin therapy before and throughout the 12 months of aftershocks that followed the earthquake. All patients received insulin therapy via pens with replaceable cartridges or continuous subcutaneous insulin infusion (CSII). Most patients needed four daily insulin injections with rapid- and long-acting insulins. Nineteen percent of patients had the CSII therapy using rapid-acting insulin. The mean HbA1c level in all patients increased significantly (P<0.01) from 6.7+/-0.9% to 7.0+/-1.0% in the third month, peaked at the fifth month, and decreased at 12 months. Sixty percent of the patients stayed in their own houses after the initial shock, while 40% of patients moved into other houses. Seventeen percent of the patients had severely destroyed houses. The median PTSD score was low in all patients. Within 1 month after the earthquake, the pens with replaceable cartridges were discontinued and disposable pens with prefilled insulin cartridges were used. The incidence of nephropathy increased by 7% by the third month and returned to the pre-earthquake level by the sixth month. Over the 12-month observation period, no other micro- or macro-vascular diseases were newly diagnosed. One patient had transient severe acute hyperglycemia and one needed hemodialysis. However, none of the patients had ketoacidosis, and no other clinical manifestations of disease were noted. In conclusion, it is essential that neighboring organizations respond quickly with sufficient medical support for diabetic patients with insulin therapy following an earthquake. In particular, treatment with rapid- and long-acting insulin injections via disposable pens with prefilled insulin cartridges or CSII therapy is useful during a disaster. To take the medical support, patients should always have a note or copy of their medical records, including medical history and medications used.
2004年10月23日下午5点56分，日本新潟县中越地区发生里氏6.8级大地震，该地区为多山村的乡村地区。日本烈度等级5 - 6级的强烈余震持续了2个月。我们调查了65名接受胰岛素治疗的1型糖尿病患者在地震后余震的12个月期间及之前糖化血红蛋白（HbA1c）水平的变化。所有患者通过可更换笔芯的胰岛素笔或持续皮下胰岛素输注（CSII）接受胰岛素治疗。大多数患者每天需要注射四次速效和长效胰岛素。19%的患者采用速效胰岛素进行CSII治疗。所有患者的平均HbA1c水平在第三个月从6.7±0.9%显著升高（P<0.01）至7.0±1.0%，在第五个月达到峰值，12个月时下降。60%的患者在初次地震后留在自己家中，40%的患者搬到了其他房屋。17%的患者房屋严重受损。所有患者的创伤后应激障碍（PTSD）评分中位数较低。地震后1个月内，可更换笔芯的胰岛素笔停用，改用预装胰岛素笔芯的一次性胰岛素笔。到第三个月，肾病发病率增加了7%，到第六个月恢复到震前水平。在12个月的观察期内，没有新诊断出其他微血管或大血管疾病。1例患者出现短暂性严重急性高血糖，1例需要血液透析。然而，没有患者发生酮症酸中毒，也未观察到其他疾病临床表现。总之，地震后邻近组织必须迅速为接受胰岛素治疗的糖尿病患者提供足够的医疗支持。特别是，在灾难期间，通过预装胰岛素笔芯的一次性胰岛素笔进行速效和长效胰岛素注射治疗或CSII治疗很有用。为了获得医疗支持，患者应始终携带病历记录或副本，包括病史和所用药物。
