Boucher-Berry Claudia, Parton Elaine A, Alemzadeh Ramin
Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital of Illinois, University of Illinois at Chicago, 840 S. Wood Street, M/C 856, 330 CSN, Chicago, IL 60612 USA.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI USA.
J Diabetes Metab Disord. 2016 Oct 18;15:47. doi: 10.1186/s40200-016-0271-5. eCollection 2016.
While higher total daily dose (TDD) of insulin has been associated with excess weight gain on insulin pump therapy, the role of higher total basal dose (TBD) of insulin on weight gain has not been studied. We evaluated the impact of higher TBD on weight gain in relationship to glycosylated hemoglobin (HbA1c), hypoglycemic episodes, and change in body mass index (BMI) z score in a group of pediatric patients with type 1 diabetes mellitus (T1DM).
One-year data from 91 (54 Female/37 Male) patients (2.3-17.8 years of age), transitioned from basal-bolus regimen to insulin pump therapy were reviewed. Patients were divided into two groups based on changes in BMI z score: Group 1 (no change or decrease) and Group 2 (increase).
Thirty-three patients in Group 1 and 58 patients in Group 2. The two groups had similar TDD (0.9 ± 0.2 vs. 0.8 ± 0.2 U/kg/day), however Group 1 had a higher bolus: basal insulin ratio (1.8 ± 0.6 vs. 1.5 ± 0.6, < 0.05). While Groups 1 and 2 had similar HbA1c values (7.7 ± 0.7 vs. 7.70 ± 0.6 %; = 0.79) and activity levels (2.2 ± 0.6 vs. 2.2 ± 0.7; = 0.15), Group 2 had higher rates of hypoglycemic episodes (1.0 ± 0.4 vs. 1.5 ± 0.9, < 0.01).
Excess weight gain was associated with lower bolus to basal insulin ratios independent of glycemic control and activity level. Evaluation of bolus and basal insulin doses during insulin therapy is warranted in order to avoid excess weight gain.
虽然胰岛素泵治疗中每日胰岛素总剂量（TDD）较高与体重过度增加有关，但胰岛素基础总剂量（TBD）较高对体重增加的影响尚未得到研究。我们评估了较高的TBD对一组1型糖尿病（T1DM）儿科患者体重增加的影响，并分析其与糖化血红蛋白（HbA1c）、低血糖发作以及体重指数（BMI）z评分变化的关系。
回顾了91例（54例女性/37例男性）年龄在2.3至17.8岁之间从基础-餐时胰岛素治疗方案转换为胰岛素泵治疗的患者的一年数据。根据BMI z评分的变化将患者分为两组：第1组（无变化或降低）和第2组（升高）。
第1组有33例患者，第2组有58例患者。两组的TDD相似（0.9±0.2 vs. 0.8±0.2 U/kg/天），但第1组的餐时胰岛素与基础胰岛素比例更高（1.8±0.6 vs. 1.5±0.6，P<0.05）。虽然第1组和第2组的HbA1c值相似（7.7±0.7 vs. 7.70±0.6%；P=0.79）且活动水平相似（2.2±0.6 vs. 2.2±0.7；P=0.15），但第2组的低血糖发作率更高（1.0±0.4 vs. 1.5±0.9，P<0.01）。
体重过度增加与较低的餐时胰岛素与基础胰岛素比例有关，且与血糖控制和活动水平无关。为避免体重过度增加，在胰岛素治疗期间有必要评估餐时胰岛素和基础胰岛素剂量。
