Sämann A, Lehmann T, Kloos C, Braun A, Hunger-Dathe W, Wolf G, Müller U A
Department of Internal Medicine III, Friedrich-Schiller-University, Jena, Germany.
Diabet Med. 2008 May;25(5):592-6. doi: 10.1111/j.1464-5491.2008.02406.x.
To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes.
Quality-assurance project with assessment of participants 1 year after participation in a DTTP (5-day inpatient course, groups < or = 10 patients, fixed curriculum of education/training, introduction of dietary freedom). Before-after analyses of participants aged 12-15, 15-18, 18-21 and 21-24 years. Main outcome measures were HbA1c, SH and SKA.
For the 1592 participants, aged 12 to 24 years, mean age at enrolment was 19 +/- 3 years, mean duration of diabetes was 7.3 +/- 5.4 (range 0.3-24) years, mean baseline HbA1c declined from 8.8 +/- 2.3% to 8.1 +/- 2.0%. The incidence of SH was 0.31 vs. 0.11 events/patient/year; the incidence of SKA 0.17 vs. 0.07 events/patient/year. In mixed effects models taking into account effects of centres, age and diabetes duration, the mean difference was -0.64%[P < 0.001, 95% confidence interval (CI) -0.79 to -0.5] for HbA1c, -0.2 events/patient/year (P < 0.0001, 95% CI -0.28 to -0.12) for SH and -0.1 events/patient/year (P < 0.0001, 95% CI -0.14 to -0.06) for SKA.
Adolescents and young adults with Type 1 diabetes benefit from participation in a standard DTTP for flexible, intensive insulin therapy and dietary freedom.
评估糖尿病治疗与教学计划（DTTP）对1型糖尿病青少年和青年糖化血红蛋白（HbA1c）、严重低血糖（SH）及严重酮症酸中毒（SKA）的治疗效果。
一项质量保证项目，在参与者参加DTTP（5天住院课程，每组≤10名患者，固定的教育/培训课程，引入饮食自由）1年后对其进行评估。对年龄在12 - 15岁、15 - 18岁、18 - 21岁和21 - 24岁的参与者进行前后分析。主要观察指标为HbA1c、SH和SKA。
1592名年龄在12至24岁的参与者，入组时平均年龄为19±3岁，糖尿病平均病程为7.3±5.4（范围0.3 - 24）年，平均基线HbA1c从8.8±2.3%降至8.1±2.0%。SH的发生率为0.31次/患者/年，而干预后为0.11次/患者/年；SKA的发生率为0.17次/患者/年，干预后为0.07次/患者/年。在考虑中心、年龄和糖尿病病程影响的混合效应模型中，HbA1c的平均差值为 - 0.64%[P < 0.001，95%置信区间（CI） - 0.79至 - 0.5]，SH为 - 0.2次/患者/年（P < 0.0001，95% CI - 0.28至 - 0.12），SKA为 - 0.1次/患者/年（P < 0.0001，95% CI - 0.14至 - 0.06）。
1型糖尿病青少年和青年通过参与标准的DTTP接受灵活、强化胰岛素治疗及饮食自由，可从中获益。
