Department of Paediatrics, Herlev Hospital, Arkaden, Turkisvej 14, DK 2730 Herlev, Denmark.
Diabetologia. 2013 May;56(5):995-1003. doi: 10.1007/s00125-013-2850-z. Epub 2013 Feb 7.
AIMS/HYPOTHESIS: We investigated the long-term impact of diabetic ketoacidosis (DKA) at onset on metabolic regulation and residual beta cell function in a Danish population with type 1 diabetes.
The study is based on data from DanDiabKids, a Danish national diabetes register for children. The register provides clinical and biochemical data on patients with type 1 diabetes diagnosed in 1996-2009 and then followed-up until 1 January 2012. Repeated-measurement models were used as statistical methods.
The study population comprised 2,964 children <18 years. The prevalence of DKA at diagnosis was 17.9%. Of the total subjects, 8.3% had mild, 7.9% had moderate and 1.7% had severe DKA. DKA (moderate and severe) was associated with increased HbA1c (%) levels (0.24; 95% CI 0.11, 0.36; p = 0.0003) and increased insulin dose-adjusted HbA1c (IDAA1c, 0.51; 95% CI 0.31, 0.70; p < 0.0001) during follow-up, after adjustment for covariates. Children without a family history of diabetes were more likely to present with DKA (19.2% vs 8.8%, p < 0.0001); however, these children had a lower HbA1c (%) level over time (-0.35; 95% CI -0.46, -0.24; p < 0.0001). Continuous subcutaneous insulin infusion (CSII) was associated with a long-term reduction in HbA1c, changing the effect of DKA, after adjustment for covariates (p < 0.0001).
CONCLUSIONS/INTERPRETATION: DKA at diagnosis was associated with poor long-term metabolic regulation and residual beta cell function as assessed by HbA1c and IDAA1c, respectively; however, CSII treatment was associated with improvement in glycaemic regulation and residual beta cell function, changing the effect of DKA at onset in our population.
目的/假设：我们研究了丹麦 1 型糖尿病患者中发病时糖尿病酮症酸中毒（DKA）对代谢调节和残留β细胞功能的长期影响。
该研究基于丹麦国家儿童糖尿病登记处 DanDiabKids 的数据。该登记处提供了 1996 年至 2009 年期间诊断为 1 型糖尿病的患者的临床和生化数据，然后随访至 2012 年 1 月 1 日。重复测量模型被用作统计方法。
研究人群包括 2964 名<18 岁的儿童。诊断时 DKA 的患病率为 17.9%。在所有受试者中，8.3%有轻度 DKA，7.9%有中度 DKA，1.7%有重度 DKA。DKA（中重度）与 HbA1c（%）水平升高（0.24；95%置信区间 0.11，0.36；p = 0.0003）和胰岛素剂量调整后 HbA1c（IDAA1c）升高（0.51；95%置信区间 0.31，0.70；p < 0.0001）相关，在调整了协变量后。无糖尿病家族史的儿童更有可能出现 DKA（19.2%比 8.8%，p < 0.0001）；然而，这些儿童的 HbA1c（%）水平随着时间的推移而降低（-0.35；95%置信区间 -0.46，-0.24；p < 0.0001）。连续皮下胰岛素输注（CSII）与 HbA1c 调整后 DKA 相关，在调整了协变量后，DKA 的作用发生了变化（p < 0.0001）。
结论/解释：发病时的 DKA 与 HbA1c 和 IDAA1c 分别评估的长期代谢调节和残留β细胞功能不良有关；然而，CSII 治疗与血糖调节和残留β细胞功能的改善有关，改变了我们人群中发病时 DKA 的作用。
