实现 ADA/ISPAD 临床指南目标与 1 型糖尿病青少年的胰岛素敏感性和心肺功能适应性提高相关：RESISTANT 和 EMERALD 研究的结果。RESISTANT 研究即 1 型和 2 型糖尿病胰岛素抵抗研究，EMERALD 研究即二甲双胍对 1 型糖尿病青少年心血管功能影响的研究。
Achieving ADA/ISPAD clinical guideline goals is associated with higher insulin sensitivity and cardiopulmonary fitness in adolescents with type 1 diabetes: Results from RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) Studies.
机构信息
Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, Colorado.
Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado.
出版信息
Pediatr Diabetes. 2018 May;19(3):436-442. doi: 10.1111/pedi.12598. Epub 2017 Oct 30.
OBJECTIVE
Most youth with type 1 diabetes do not meet the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) targets for hemoglobin A1c (HbA1c), blood pressure (BP), lipids, and body mass index (BMI). We hypothesized that ISPAD/ADA goal achievement would be associated with better insulin sensitivity (IS) and cardiopulmonary fitness.
METHODS
IS was quantified as glucose infusion rate (GIR) from a hyperinsulinemic-euglycemic clamp in youth with type 1 diabetes from the RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) (n = 86) and Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD) (n = 41) cohorts (n = 127; age 15.7 ± 2.2 years, 52% girls). Cardiopulmonary fitness was measured as peak oxygen consumption (VO peak/kg) during upright (RESISTANT) or supine (EMERALD) cycle ergometry and were stratified by cycle type. Goal achievement was defined as HbA1c < 7.5%, BP < 90th percentile, LDL-cholesterol < 100 mg/dL, HDL-cholesterol > 35 mg/dL, triglycerides < 150 mg/dL and BMI < 85th percentile. Participants were stratified into 3 groups: achieving 0-3 goals (n = 52), 4 goals (n = 48), and 5-6 goals (n = 27). Differences between groups were examined with generalized linear models.
RESULTS
IS was lower in youth who met 0-3 goals (5.2 ± 3.4 mg/kg/min) vs those who met 4 goals (7.4 ± 4.1 mg/kg/min, P = .04) and those who met 5-6 goals (8.5 ± 4.3 mg/kg/min, P = .003), and remained significant after adjustments for sex and diabetes duration. Upright VO peak was lower in youth who met 0-3 goals (25.8 ± 4.6 mL/kg/min) vs those who met 4 goals (33.0 ± 7.8 mL/kg/min, P = .01) and those who met 5-6 goals (33.2 ± 4.4 mL/kg/min, P = .004). Similar and significant relationships were observed in EMERALD participants for supine VO peak.
CONCLUSIONS
ADA/ISPAD goal achievement was associated with greater IS and cardiopulmonary fitness.
目的
大多数 1 型糖尿病青少年不符合美国糖尿病协会 (ADA) 和国际儿童青少年糖尿病协会 (ISPAD) 对血红蛋白 A1c (HbA1c)、血压 (BP)、血脂和体重指数 (BMI) 的目标要求。我们假设 ISPAD/ADA 目标的实现与更好的胰岛素敏感性 (IS) 和心肺功能有关。
方法
在来自 RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT)（n = 86）和 Effects of MEtformin on CardiovasculaR Function in AdoLescents with Type 1 Diabetes (EMERALD)（n = 41）队列的 15.7 ± 2.2 岁（52%为女性）的 1 型糖尿病青少年中，通过高胰岛素-正葡萄糖钳夹试验量化 IS，作为葡萄糖输注率 (GIR)。心肺功能通过直立 (RESISTANT) 或仰卧 (EMERALD) 踏车运动时的峰值耗氧量 (VO peak/kg) 进行测量，并根据运动类型进行分层。目标达标定义为 HbA1c < 7.5%、BP < 90 百分位、LDL-胆固醇 < 100 mg/dL、HDL-胆固醇 > 35 mg/dL、甘油三酯 < 150 mg/dL 和 BMI < 85 百分位。参与者被分为 3 组：达到 0-3 个目标（n = 52）、4 个目标（n = 48）和 5-6 个目标（n = 27）。使用广义线性模型检查组间差异。
结果
与达到 4 个目标（7.4 ± 4.1 mg/kg/min，P =.04）和达到 5-6 个目标（8.5 ± 4.3 mg/kg/min，P =.003）的青少年相比，达到 0-3 个目标（5.2 ± 3.4 mg/kg/min）的青少年的 IS 较低，这种差异在调整性别和糖尿病持续时间后仍然显著。达到 0-3 个目标（25.8 ± 4.6 mL/kg/min）的青少年的直立 VO peak 低于达到 4 个目标（33.0 ± 7.8 mL/kg/min，P =.01）和达到 5-6 个目标（33.2 ± 4.4 mL/kg/min，P =.004）的青少年。在 EMERALD 参与者中，仰卧 VO peak 也观察到了类似且显著的关系。
结论
ADA/ISPAD 目标的实现与更高的 IS 和心肺功能有关。
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