Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
Pediatr Diabetes. 2011 Nov;12(7):627-31. doi: 10.1111/j.1399-5448.2011.00759.x. Epub 2011 Mar 24.
The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients.
Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison.
On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C.
Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
本研究旨在评估儿童患者胰岛素剂量过低和过高的发生率。
本研究为横断面研究，纳入了来自 21 家糖尿病门诊的 241 名（年龄 14.0 ± 2.7 岁，42.5%为男性）1 型糖尿病患儿。从临床记录中获取血红蛋白 A1c（HbA1c）、身高和体重。通过糖尿病自我管理情况调查问卷（DSMP）访谈对患者进行评估。采用 t 检验、U 检验和卡方检验进行比较。
根据 DSMP，103 名（42.7%）患者（A 组）表现出对治疗性胰岛素方案的依从性，而 71 名（29.5%）患者（B 组）承认有意超量或/和减少胰岛素剂量。67 名（27.8%）青少年（C 组）报告存在管理问题，导致意外的不适当胰岛素剂量。与 A 组相比，B 组患者年龄更大[15.0（±2.5）岁比 14.0（±2.5）岁，p < 0.01]、起病年龄更大[9.5（±3.6）岁比 8.3（±3.8）岁，p = 0.05]、女性更多（69 比 45.6%）、实际 HbA1c 更高[8.7 ± 1.7%比 7.8 ± 1.2%]、前一年平均 HbA1c 更高[8.3 ± 1.6%比 7.9 ± 1.2%]（p < 0.01）。A 组和 C 组之间无显著差异。
儿童和青少年故意超量胰岛素的情况与漏用胰岛素一样普遍。女性风险更高。
