强化胰岛素教育治疗的 1 型糖尿病患者视网膜病变的患病率及其与血糖控制参数的关系。

The prevalence of retinopathy in patients with type 1 diabetes treated with education-based intensified insulin therapy and its association with parameters of glucose control.

机构信息

Vista Klinik Binningen, Binningen, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland; Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

Division of Endocrinology & Diabetes, Stadtspital Triemli, Zürich, Switzerland.

出版信息

Diabetes Res Clin Pract. 2019 Feb;148:234-239. doi: 10.1016/j.diabres.2019.01.016. Epub 2019 Jan 23.

DOI:10.1016/j.diabres.2019.01.016

PMID:30684505

Abstract

AIM

Prevalence of retinopathy (DR) in patients with type 1 diabetes treated with education-based intensified insulin therapy (EBIIT) and its association with parameters of glucose control.

METHODS

151 patients with mean diabetes duration of 14.3 years [SD ± 5.8]) were analyzed. Eyes were examined using standardized 7 field ETDRS (Early Treatment Diabetic Retinopathy Study) settings and images analyzed by a professional external reading center. The glucose exposure over time was defined as HbA1c years, i.e. the sum of the differences between annual mean HbA1c (in %) minus the ideal HbA1c of 6.0% (42 mmol/mol) for each diabetes year (e.g. HbA1c of 8% (64 mmol/mol) over 6 years gives an excess HbA1c of 2.0% (22 for mmol/mol) for 6 years, resulting in 12 HbA1c years (or 131 for mmol/mol)).

RESULTS

The median (interquartile range) of individual mean HbA1c was 7.3% (6.8-7.8) [56 mmol/mol (51-62)]. and the median HbA1c years was 16.8 (9.1-29.1) [183 mmol/mol (99-319)]. No evidence for DR was found in 59 patients (39%), stage 1 DR in 43 (28.5%), stage 2 in 41 (27.2%), stage 3 in 7 (4.6%) and proliferative DR stage 4 in 1 patient. The best correlation between severity of DR and diabetes control measures was found for HbA1c years (Pearson r = 0.41, p < 0.001).

CONCLUSIONS

In type 1 diabetes EBIIT is associated with good diabetes control and a low prevalence of DR. The cumulative glucose exposure over time given as HbA1c years is the best predictor for development of DR. ClinicalTrials.gov Identifier: NCT02307110.

摘要

目的

评估接受基于教育的强化胰岛素治疗（EBIIT）的 1 型糖尿病患者的视网膜病变（DR）患病率及其与血糖控制参数的关系。

方法

分析了 151 例平均糖尿病病程为 14.3 年[标准差（±5.8）]的患者。使用标准化的 7 区域 ETDRS（早期糖尿病视网膜病变研究）设置检查眼睛，并由专业的外部阅读中心分析图像。血糖暴露时间定义为 HbA1c 年，即每年平均 HbA1c（%）与理想 HbA1c（6.0%[42mmol/mol]）之间的差值之和减去每个糖尿病年（例如，HbA1c 为 8%[64mmol/mol]的 6 年，导致 6 年的 HbA1c 过量为 2.0%（22mmol/mol），导致 12 HbA1c 年（或 131mmol/mol））。

结果

个体平均 HbA1c 的中位数（四分位距）为 7.3%（6.8-7.8）[56mmol/mol（51-62）]，HbA1c 年的中位数为 16.8（9.1-29.1）[183mmol/mol（99-319）]。59 例（39%）患者未发现 DR，43 例（28.5%）为 1 期 DR，41 例（27.2%）为 2 期 DR，7 例（4.6%）为 3 期 DR，1 例（0.6%）为 4 期增殖性 DR。DR 严重程度与糖尿病控制措施之间的相关性最好的是 HbA1c 年（Pearson r=0.41，p<0.001）。