Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2018 Dec;41(6):348-355. doi: 10.1016/j.bj.2018.10.005. Epub 2019 Jan 11.
This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy.
A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed.
Of the 825 patients, 226 receiving a premixed regimen were matched to the same number of patients receiving a basal-bolus regimen. In the matched cohort, DKA (10.62% vs. 5.31%; p = 0.037) and severe hypoglycemic episodes (25.22% vs. 10.62%; p < 0.001) were significantly higher in patients receiving a premixed regimen than those receiving a basal-bolus regimen. The median reduction of HbA1c, compared to the treatment-naive level, was better with the basal-bolus regimen than with the premixed regimen in both matched (2.2 vs. 2.1; p = 0.034) and the entire (3.1 vs. 1.9; p < 0.001) cohorts. Regardless of insulin regimen, a higher HbA1c level was significantly linked to higher risk of DKA development (hazard ratio [HR] 1.35 per 1% increase; p < 0.001) once the HbA1c level was ≥7.5%.
A premixed insulin regimen may increase the DKA occurrence rate and severe hypoglycemic risk in children, adolescents, and young adults with TIDM, compared to a basal-bolus regimen. Tight glycemic control with HbA1c < 7.5% may prevent the increased risk of DKA.
本研究比较了接受基础-餐时胰岛素或预混胰岛素治疗的儿童、青少年和年轻成人 1 型糖尿病患者的糖尿病酮症酸中毒 (DKA) 和严重低血糖事件发生率，以及血糖控制情况。
本研究回顾性纳入了 2001 年至 2015 年期间使用基础-餐时或预混胰岛素方案的 825 名年龄≤20 岁的 1 型糖尿病患者。分析了诊断后 DKA、严重低血糖的发生率以及随访期间糖化血红蛋白 A1c（HbA1c）的改善水平。
在 825 名患者中，226 名接受预混胰岛素治疗的患者与接受基础-餐时胰岛素治疗的患者进行了匹配。在匹配队列中，接受预混胰岛素治疗的患者 DKA（10.62% vs. 5.31%；p=0.037）和严重低血糖发作（25.22% vs. 10.62%；p<0.001）的发生率显著高于接受基础-餐时胰岛素治疗的患者。与治疗前相比，基础-餐时胰岛素治疗组的 HbA1c 中位数下降幅度（2.2% vs. 2.1%；p=0.034）和预混胰岛素治疗组（3.1% vs. 1.9%；p<0.001）均优于预混胰岛素治疗组。无论胰岛素方案如何，一旦 HbA1c 水平≥7.5%，HbA1c 水平升高与 DKA 发生风险显著相关（每增加 1%，风险比[HR]为 1.35；p<0.001）。
与基础-餐时胰岛素治疗相比，预混胰岛素治疗可能会增加儿童、青少年和年轻成人 1 型糖尿病患者的 DKA 发生率和严重低血糖风险。将 HbA1c 控制在<7.5%可能有助于预防 DKA 风险增加。
