Hanas Ragnar, Lindgren Fredrik, Lindblad Bengt
Department of Pediatrics, Uddevalla Hospital, Uddevalla, Sweden.
Pediatr Diabetes. 2009 Feb;10(1):33-7. doi: 10.1111/j.1399-5448.2008.00441.x. Epub 2008 Aug 21.
The aim was to investigate triggering factors and insulin pump usage (continuous subcutaneous insulin infusion, CSII) at diabetic ketoacidosis (DKA). Data from 1999 and 2000 were collected retrospectively from Sweden. In 1999 and 2000, 7.4 and 11.0%, respectively, of children with diabetes used CSII. One hundred and forty-two episodes of DKA (pH < 7.30) were identified in 115 children (DKA at onset not included). Their hemoglobin A1c (HbA1c) was 10.1 +/- 2.0%, age 14.6 +/- 3.1 yr (range 1.5-19.9 yr), and diabetes duration 6.6 +/- 3.5 yr (range 0.4-17.7 yr). Fourteen persons (seven girls) had more than one episode of DKA. Reported causes of DKA were missed insulin doses (48.6%), gastroenteritis (14.1%), technical pump problems (12.7%), infection (13.4%), social problems (1.4%), unknown (5.6%), and not stated (4.2%). Alcohol was involved in eight episodes and drugs in one. Thirty of 115 patients (19 girls) used insulin pumps. The overall DKA incidence was 1.4/100 patient years in 1999 and 1.7/100 patient years in 2000. For insulin pump users, the DKA incidence was 3.2/100 patient years in 1999 and 3.6/100 patient years in 2000. HbA1c at DKA admission was lower for CSII users than patients who used injections (9.1 +/- 1.5 vs. 10.8 +/- 2.2%, p < 0.01), but pH and age did not differ. CSII had been used for 6 months (median) before the DKA episode. In conclusion, the DKA frequency in CSII users was approximately twice that of patients who used injections. Seventy-seven percent of the episodes occurred within 1 yr after CSII start. The high number of events reported to be caused by gastroenteritis is alarming because this may reflect a misinterpretation of DKA symptoms.
目的是调查糖尿病酮症酸中毒（DKA）的触发因素及胰岛素泵使用情况（持续皮下胰岛素输注，CSII）。回顾性收集了瑞典1999年和2000年的数据。1999年和2000年，分别有7.4%和11.0%的糖尿病儿童使用CSII。在115名儿童中识别出142次DKA发作（pH<7.30，不包括起病时即发生DKA的情况）。他们的糖化血红蛋白（HbA1c）为10.1±2.0%，年龄14.6±3.1岁（范围1.5 - 19.9岁），糖尿病病程6.6±3.5年（范围0.4 - 17.7年）。14人（7名女孩）有不止一次DKA发作。报告的DKA病因包括胰岛素剂量遗漏（48.6%）、肠胃炎（14.1%）、胰岛素泵技术问题（12.7%）、感染（13.4%）、社会问题（1.4%）、不明原因（5.6%）以及未提及（4.2%）。8次发作与酒精有关，1次与药物有关。115名患者中有30人（19名女孩）使用胰岛素泵。1999年总体DKA发病率为1.4/100患者年，2000年为1.7/100患者年。对于胰岛素泵使用者，1999年DKA发病率为3.2/100患者年，2000年为3.6/100患者年。DKA入院时，CSII使用者的HbA1c低于注射胰岛素的患者（9.1±1.5 vs. 10.8±2.2%，p<0.01），但pH值和年龄无差异。DKA发作前CSII已使用6个月（中位数）。总之，CSII使用者的DKA发生率约为注射胰岛素患者的两倍。77%的发作发生在开始使用CSII后的1年内。报告中因肠胃炎导致的发作数量较多，令人担忧，因为这可能反映了对DKA症状的误解。
