Harry Dorchy, Diabetology Clinic, University Children's Hospital Queen Fabiola, Université Libre de Bruxelles, 1020 Brussels, Belgium.
World J Diabetes. 2015 Feb 15;6(1):1-7. doi: 10.4239/wjd.v6.i1.1.
The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications (retinopathy, neuropathy, nephropathy, cardiovascular disease, etc.) by maintaining blood glucose concentrations close to normal level. Glycated hemoglobin levels (HbA1c) provide a good criterion of overall glycemic control. The Hvidoere Study Group (HSG) on Childhood Diabetes, founded in 1994, is an international group representing about twenty highly experienced pediatric centers from Europe, North America, Japan and Australia. Four international comparisons of metabolic control (1995, 1998, 2005, 2009) have been performed. The one center that has consistently had the lowest HbA1c values (approximate 7.3% or 56.3 mmol/mol) is my center in Brussels. This is more often obtained with a twice-daily free-mixed regimen with additional supplemental fast insulins ad hoc. The so-called "Dorchy's recipes" are summarized. The conclusion is that the number of daily insulin injections, 2 or ≥ 4, or the use of pumps, by itself does not necessarily give better results. Intensified therapy should not depend upon the number of insulin doses per day, by syringe, pen or pump but rather should be redefined as to intent-to-treat ascertainment (i.e., goals). When there are no mutually agreed upon goals for BG and/or HbA1c, when there is insufficient education and psychosocial support by the medical team or at home, there is likely to be poor outcomes, as shown by the HSG. One of our recipes is not to systematically replace rapid-acting human insulins by fast-acting analogues. Because the multicenter studies of the HSG, performed in developed countries without financial restriction, show that treatment of childhood diabetes is inadequate in general and that levels of HbA1c are very different, diabetes treatment teams should individually explore the reasons for failure, without any prejudice or bias. Any dogmatism must be avoided. Treatment cost vs results must also be taken into account.
治疗 1 型糖尿病儿童、青少年和成人的主要目标是通过将血糖浓度维持在接近正常水平来提高生活质量并避免长期并发症（视网膜病变、神经病变、肾病、心血管疾病等）。糖化血红蛋白（HbA1c）水平是整体血糖控制的良好标准。Hvidoere 儿童糖尿病研究组（HSG）成立于 1994 年，是一个代表来自欧洲、北美、日本和澳大利亚的大约二十个经验丰富的儿科中心的国际组织。已经进行了四次代谢控制的国际比较（1995 年、1998 年、2005 年和 2009 年）。始终具有最低 HbA1c 值（约 7.3%或 56.3mmol/mol）的一个中心是我在布鲁塞尔的中心。这更常通过两次每日自由混合方案并额外补充快速胰岛素来实现。总结了所谓的“Dorchy 食谱”。结论是，每日胰岛素注射次数，2 次或≥4 次，或使用泵，本身并不一定能带来更好的结果。强化治疗不应取决于每天通过注射器、笔或泵进行的胰岛素剂量次数，而应重新定义为治疗意向的确定（即目标）。当没有达成一致的 BG 和/或 HbA1c 目标时，当医疗团队或家庭提供的教育和心理社会支持不足时，治疗结果可能不佳，HSG 表明了这一点。我们的一个食谱是不系统地用速效类似物替代速效人胰岛素。由于 HSG 在没有财务限制的发达国家进行的多中心研究表明，儿童糖尿病的治疗总体上不足，HbA1c 水平差异很大，因此糖尿病治疗团队应该单独探索失败的原因，而不带有任何偏见或偏见。任何教条主义都必须避免。还必须考虑治疗成本与结果。
