Department of Paediatrics, University Hospital Rostock, Hannover, Germany.
Clin Endocrinol (Oxf). 2013 Nov;79(5):641-7. doi: 10.1111/cen.12093. Epub 2013 Apr 19.
This cross-sectional observational cohort study was designed to investigate i) whether glycaemic variability in paediatric patients with type 1 diabetes is lower in those using an insulin pump (CSII) compared with those using multiple daily insulin injections (MDI) and ii) whether urinary F2 -isoprostanes and/or urinary prostaglandin F2 excretion as surrogate marker of oxidative stress and cyclooxygenase activity are associated with glycaemic variability.
48 paediatric patients with type 1 diabetes (22 using an insulin pump) underwent an ambulatory 3-day continuous glucose monitoring. All patients continued with normal daily activities and collected urine for two consecutive 24 h periods. The glucose pentagon was used to calculate the glycaemic risk parameter.
Insulin requirements, HDL-cholesterol, the mean of glycaemic excursions (P < 0·01) and the standard deviation of mean glucose concentration (P < 0·05) were significantly lower in patients with CSII compared with those using MDI. By contrast, averaged HbA1c during the last twelve months as well as at the time of sensor insertion did not differ significantly between both groups. Summarizing characteristic parameter of acute and long-term metabolic control into the glucose pentagon revealed a significantly lower glycaemic risk parameter in CSI patients compared with both, healthy subjects and patients using MDI (P < 0·05).
Paediatric patients with type 1 diabetes using an insulin pump presented with lower glycaemic variability and a concomitantly lower glycaemic risk parameter compared with those using MDII. Whether these findings translate into a lower risk of diabetes associated cardiovascular complications remains to be elucidated.
本横断面观察性队列研究旨在探讨:i)使用胰岛素泵(CSII)的 1 型糖尿病患儿血糖变异性是否低于使用多次每日胰岛素注射(MDI)的患儿;ii)尿 F2-异前列腺素和/或尿前列腺素 F2 排泄作为氧化应激和环氧化酶活性的替代标志物是否与血糖变异性相关。
48 名 1 型糖尿病患儿(22 名使用胰岛素泵)接受了为期 3 天的门诊连续血糖监测。所有患者继续正常日常活动,并连续收集 2 个 24 小时的尿液。血糖五边形用于计算血糖风险参数。
CSII 组的胰岛素需求、HDL 胆固醇、血糖波动平均值(P < 0·01)和平均血糖浓度标准差(P < 0·05)显著低于 MDI 组。相比之下,CSII 组和 MDI 组在最后 12 个月的平均糖化血红蛋白和传感器插入时的糖化血红蛋白没有显著差异。将急性和长期代谢控制的特征参数总结到血糖五边形中,发现 CSI 组的血糖风险参数明显低于健康受试者和 MDI 组(P < 0·05)。
使用胰岛素泵的 1 型糖尿病患儿血糖变异性较低,同时血糖风险参数也较低。这些发现是否转化为与糖尿病相关的心血管并发症风险降低仍有待阐明。