Barbara Davis Center for Diabetes, School of Medicine, University of Colorado, Aurora, CO.
Colorado School of Public Health, University of Colorado, Aurora, CO.
Diabetes Care. 2017 Sep;40(9):1249-1255. doi: 10.2337/dc17-0558. Epub 2017 Jun 30.
This study tested the hypothesis that diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control independently of established risk factors.
This was a prospective cohort study of 3,364 Colorado residents diagnosed with type 1 diabetes before 18 years of age, in 1998-2012, and monitored for up to 15 years. Of those, 1,297 (39%) had DKA at diagnosis (blood glucose >250 mg/dL, and venous pH <7.3 or bicarbonate <15 mEq/L). Severity of DKA was further classified as mild/moderate (pH 7.10-7.29 or bicarbonate 5-14 mEq/L) or severe (pH <7.10 or bicarbonate <5 mEq/L). HbA levels were measured an average of 2.8 times/year (median 20 HbA values/patient). A linear mixed model was used to examine the effect of DKA on long-term HbA levels, adjusting for age, race/ethnicity, sex, family history of diabetes, health insurance, and insulin pump use.
DKA at diagnosis predicted persistently elevated HbA levels. Compared with children without DKA, HbA tracked 1.4% (15.3 mmol/mol) higher in those with severe DKA ( < 0.0001) and 0.9% (9.8 mmol/mol) higher in those with mild/moderate DKA at diagnosis ( < 0.0001). These effects were independent of ethnic minority status or lack of health insurance at diagnosis that predicted higher HbA by 0.5% (5.5 mmol/mol; < 0.0001) and 0.2% (2.2 mmol/mol; < 0.0001), respectively. Insulin pump use or having a parent or sibling with type 1 diabetes predicted lower long-term HbA by, respectively, 0.4% (4.4 mmol/mol; < 0.0001) and 0.2% (2.2 mmol/mol; = 0.01).
DKA at diagnosis of type 1 diabetes in children predicts poor long-term glycemic control, independent of demographic and socioeconomic factors.
本研究旨在检验以下假说，即儿童在 1 型糖尿病诊断时发生糖尿病酮症酸中毒（DKA），可独立于既定风险因素预测长期血糖控制不佳。
这是一项前瞻性队列研究，纳入了 1998 年至 2012 年间在科罗拉多州居住的 3364 名 18 岁以下被诊断为 1 型糖尿病的患者，并对其进行了长达 15 年的监测。其中 1297 名（39%）患者在诊断时发生 DKA（血糖＞250mg/dL，静脉 pH＜7.3 或碳酸氢盐＜15mEq/L）。进一步将 DKA 严重程度分为轻度/中度（pH 7.10-7.29 或碳酸氢盐 5-14mEq/L）或重度（pH＜7.10 或碳酸氢盐＜5mEq/L）。HbA 水平平均每年测量 2.8 次（中位数 20 个 HbA 值/患者）。采用线性混合模型，在校正年龄、种族/民族、性别、糖尿病家族史、医疗保险和胰岛素泵使用等因素后，分析 DKA 对长期 HbA 水平的影响。
DKA 可预测持续升高的 HbA 水平。与无 DKA 的患者相比，重度 DKA 患者的 HbA 水平升高了 1.4%（15.3mmol/mol；＜0.0001），轻度/中度 DKA 患者的 HbA 水平升高了 0.9%（9.8mmol/mol；＜0.0001）。这些影响独立于少数民族身份或诊断时缺乏医疗保险，后两者分别预测 HbA 升高 0.5%（5.5mmol/mol；＜0.0001）和 0.2%（2.2mmol/mol；＜0.0001）。胰岛素泵的使用或有 1 型糖尿病的父母或兄弟姐妹分别使长期 HbA 降低 0.4%（4.4mmol/mol；＜0.0001）和 0.2%（2.2mmol/mol；=0.01）。
儿童在 1 型糖尿病诊断时发生 DKA，可独立于人口统计学和社会经济因素预测长期血糖控制不佳。
