Yan J H, Zhang Y, Zheng X Y, Luo S H, Ai H Y, Lü J, Qiu L L, Zhang X W, Yang D Z, Yao B, Weng J P
Department of Endocrinology and Metabolic Disease, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China.
Zhonghua Yi Xue Za Zhi. 2017 Feb 28;97(8):587-591. doi: 10.3760/cma.j.issn.0376-2491.2017.08.006.
To describe the insulin regimens and their associations with glycemic control and to explore factors associated with intensive insulin therapy. Patients with type 1 diabetes (T1DM) were recruited from Guangdong Type 1 Diabetes Mellitus Translational Medicine Study which was conducted in 16 centers in Guangdong province. The demographic and clinical data were collected. Patients were grouped according to different insulin regimens: insulin pump (R1), basal insulin plus regular insulin or short-acting insulin (R2), insulin injection 1-3 times per day (R3). Distribution of insulin regimens and the relationships between insulin regimens and hemoglobin A1c (HbA1c) were described. Multivariate logistic regression was used to identify factors associated with intensive insulin therapy. A total of 1 421 patients with the age of 27.8 (19.4, 38.3) years and a duration of T1DM of 3.3 (0.5, 7.1) years were recruited. There was 12.3% of patients in R1 (=175), 35.5% in R2 (=504), and 52.2% in R3 (=742), respectively. HbA1c was 8.0 (6.8, 9.3)%, 8.9 (7.1, 11.8)%, and 9.2 (7.5, 11.4)% in R1, R2, R3, respectively, and it was associated with insulin regimens (<0.001). HbA1c target rate was 32.3%, 21.1%, 17.8% in R1, R2, R3, respectively (=0.002). Older age (=1.01, =0.027), higher education level (college or above) (=1.56, =0.003), and higher household income (>30 000 yuan per year per person)(=1.45, =0.009) were associated with intensive insulin therapy in adult patients. The study suggested that insulin therapy need to be optimized in patients with T1DM. The optimization of insulin regimens and diabetes education may be helpful for improvement of glycemic control.
描述胰岛素治疗方案及其与血糖控制的关系，并探讨与强化胰岛素治疗相关的因素。1型糖尿病（T1DM）患者来自于在广东省16个中心开展的广东1型糖尿病转化医学研究。收集了人口统计学和临床数据。患者根据不同的胰岛素治疗方案分组：胰岛素泵（R1）、基础胰岛素加正规胰岛素或短效胰岛素（R2）、每日胰岛素注射1 - 3次（R3）。描述了胰岛素治疗方案的分布情况以及胰岛素治疗方案与糖化血红蛋白（HbA1c）之间的关系。采用多因素logistic回归分析确定与强化胰岛素治疗相关的因素。共招募了1421例患者，年龄为27.8（19.4，38.3）岁，T1DM病程为3.3（0.5，7.1）年。R1组患者占12.3%（=175），R2组占35.5%（=504），R3组占52.2%（=742）。R1、R2、R3组的HbA1c分别为8.0（6.8，9.3）%、8.9（7.1，11.8）%、9.2（7.5，11.4）%，且与胰岛素治疗方案相关（<0.001）。R1、R2、R3组的HbA1c达标率分别为32.3%、21.1%、17.8%（=0.002）。年龄较大（=1.01，=0.027）、教育水平较高（大专及以上）（=1.56，=0.003）以及家庭收入较高（每人每年>30000元）（=1.45，=0.009）与成年患者强化胰岛素治疗相关。该研究提示，T1DM患者的胰岛素治疗需要优化。胰岛素治疗方案的优化和糖尿病教育可能有助于改善血糖控制。
