1型糖尿病儿科队列患者的血、尿酮体监测：一项交叉研究
Blood urine ketone monitoring in a pediatric cohort of patients with type 1 diabetes: a crossover study.
作者信息
Goffinet Line, Barrea Thierry, Beauloye Véronique, Lysy Philippe A
机构信息
Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Pôle PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
出版信息
Ther Adv Endocrinol Metab. 2017 Jan;8(1-2):3-13. doi: 10.1177/2042018816681706. Epub 2016 Dec 13.
BACKGROUND
The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D).
METHODS
Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients ( = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial. Moreover, we evaluated levels of awareness of ketone production in a series of 58 patients and sometimes parents a multiple-choice questionnaire.
RESULTS
Based on self-monitoring data, patients experienced a mean of 4.8 HE/month (range 0-9.3). Patients performed accurate ketone tests more frequently during urine (46%) than during blood-testing (29%) periods ( < 0.05); while globally, 50% of ketone tests were inaccurate (i.e. without HE). Ketosis occurred significantly more often during urine (46.4%) than during blood (14.8%) monitoring ( = 0.01), although no episodes of diabetic ketoacidosis (DKA) were noticed. Duration of hyperglycemia was not different whether patients measured ketones or not, suggesting that ketone monitoring did not affect correction of glycemia. Patients evaluated blood monitoring more frequently as being practical, reliable, and useful compared with urine testing. Scores in the awareness questionnaire were globally low (36.8%) without difference between patients and their parents.
CONCLUSIONS
Although our study shows differences in outcomes (e.g. accurate use, detection of ketosis) of urine blood ketone monitoring, these did not affect the occurrence of HE. Whereas ketone monitoring is part of standardized diabetes education, its implementation in daily routine remains difficult, partly because patient awareness about mechanisms of ketosis is lacking.
背景
我们研究的目的是确定常规酮体监测对1型糖尿病（T1D）青少年高血糖事件（HE）和酮症的影响。
方法
我们在处于非缓解期的T1D儿童和青少年中进行了单中心、对照和随机研究。在两个为期6个月的交叉期内，经历高血糖事件的患者（n = 22）交替使用血酮仪或尿酮试纸检测酮体，并在临床试验完成后对筛查方法发表意见。此外，我们通过一系列58名患者（有时包括家长）的多项选择题问卷评估了酮体产生的知晓水平。
结果
根据自我监测数据，患者每月平均经历4.8次高血糖事件（范围0 - 9.3）。患者在尿酮检测期间（46%）比血酮检测期间（29%）更频繁地进行准确的酮体检测（P < 0.05）；而总体而言，50%的酮体检测不准确（即无高血糖事件）。酮症在尿酮监测期间（46.4%）比血酮监测期间（14.8%）显著更频繁发生（P = 0.01），尽管未观察到糖尿病酮症酸中毒（DKA）发作。无论患者是否检测酮体，高血糖持续时间均无差异，这表明酮体监测并未影响血糖校正。与尿酮检测相比，患者更频繁地认为血酮监测实用、可靠且有用。知晓问卷得分总体较低（36.8%），患者与其家长之间无差异。
结论
尽管我们的研究显示尿酮与血酮监测在结果（如准确使用、酮症检测）方面存在差异，但这些差异并未影响高血糖事件的发生。虽然酮体监测是标准化糖尿病教育的一部分，但其在日常实践中的实施仍然困难，部分原因是患者缺乏对酮症机制的认识。
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