Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil/CAPES Foundation, Ministry of Education, Brasilia, Brazil.
Diabet Med. 2018 Oct;35(10):1355-1363. doi: 10.1111/dme.13699. Epub 2018 Jun 19.
To investigate trajectories of daily insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes and to identify factors associated with changing insulin needs and deterioration in HbA .
The sample was a dynamic cohort of 635 children, adolescents and young adults with Type 1 diabetes from one centre. Data from clinic visits occurring over 20 years (1993-2013) were extracted from medical records. From age 7-24 years, we evaluated HbA and insulin dose according to sex, insulin regimen and weight status.
Participants provided a mean ± sd of 10.7±4.3 years of insulin dose data and 12.0±4.6 years of HbA data. At first observation, the mean ± sd age was 10.0±2.6 years, diabetes duration was 2.8±2.1 years, insulin dose was 0.8±0.2 units/kg and HbA was 74±18 mmol/mol (8.9±1.6%). Insulin dose was higher in girls at ages 8-13 years (P<0.0001 to P<0.01), but higher in boys/young men at ages 16-21 years (P<0.0001 to P=0.04). HbA was higher in girls/young women at ages 16-24 years (P<0.0001 to P=0.01). Compared with injection therapy, pump therapy was associated with lower insulin dose at ages 8-24 years (P<0.0001 to P=0.03) and lower HbA at ages 8-22 years (P<0.0001 to P=0.005). HbA did not differ between overweight/obese and normal weight individuals, but overweight/obese individuals had higher insulin dose at ages 8-13 years (P<0.0001 to P=0.03).
This longitudinal assessment identifies clinically meaningful modifiable (e.g. insulin regimen) and non-modifiable (e.g. sex) factors predictive of insulin requirements and HbA levels in young people with Type 1 diabetes; anticipatory insulin adjustments may improve glycaemic control.
研究 1 型糖尿病儿童、青少年和年轻成人的日常胰岛素剂量需求轨迹和血糖控制情况，并确定与胰岛素需求变化和 HbA 恶化相关的因素。
本研究的样本是一个来自一个中心的 635 名儿童、青少年和年轻成人的动态队列。从医疗记录中提取了 20 年来（1993-2013 年）在诊所就诊的数据。从 7-24 岁起，我们根据性别、胰岛素方案和体重状况评估了 HbA 和胰岛素剂量。
参与者提供了 10.7±4.3 年的胰岛素剂量数据和 12.0±4.6 年的 HbA 数据。首次观察时，参与者的平均年龄±标准差为 10.0±2.6 岁，糖尿病病程为 2.8±2.1 年，胰岛素剂量为 0.8±0.2 单位/公斤，HbA 为 74±18 mmol/mol（8.9±1.6%）。8-13 岁时，女性的胰岛素剂量较高（P<0.0001 至 P<0.01），但 16-21 岁时，男性/年轻男性的胰岛素剂量较高（P<0.0001 至 P=0.04）。16-24 岁时，女性/年轻女性的 HbA 较高（P<0.0001 至 P=0.01）。与注射治疗相比，泵治疗与 8-24 岁时较低的胰岛素剂量（P<0.0001 至 P=0.03）和 8-22 岁时较低的 HbA 相关（P<0.0001 至 P=0.005）。超重/肥胖者和体重正常者的 HbA 无差异，但 8-13 岁时超重/肥胖者的胰岛素剂量较高（P<0.0001 至 P=0.03）。
本纵向评估确定了与 1 型糖尿病青少年的胰岛素需求和 HbA 水平相关的具有临床意义的可改变（例如胰岛素方案）和不可改变（例如性别）因素；预期的胰岛素调整可能改善血糖控制。
