Department of Endocrinology and Diabetology, University of Leipzig, Hospital for Children and Adolescents, Leipzig, Germany.
Center for Pediatric Research Leipzig (CPL), Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, University of Leipzig, Leipzig, Germany.
Pediatr Diabetes. 2019 Jun;20(4):421-426. doi: 10.1111/pedi.12830. Epub 2019 Apr 9.
Continuous intravenous (IV) insulin infusion therapy minimizes blood glucose (BG) fluctuations and prevents metabolic deterioration in pediatric patients with type 1 diabetes (T1D) during intercurrent illness and surgery. However, data on the adequate fluid and insulin substitution in this situation is rare. We evaluated the effectiveness and safety of IV insulin therapy according to our local protocol.
Retrospective study of 124 cases of hospitalization with IV insulin therapy because of intercurrent illness (n = 78) or minor surgery (n = 46) in 62 patients with T1D (mean age: 9.6 ± 5.4 years). The patients received a glucose-electrolyte infusion and short-acting insulin (normal insulin). Infusion rate was adapted according to the BG measured hourly. Glycemic control was analyzed in subgroups subdivided by age, glycated hemoglobin (HbA1c) and reason for hospitalization.
Mean infusion time was 22 hours (range 1.5-147 hours). In 65% of the infusion time, patients' BG was within the target range (4-8 mmol/L). Critical events (BG <3 or > 15 mmol/L) were found in 6% of the infusion time. Comparison of glycemic control in subgroups for HbA1c and the reason for hospitalization revealed no significant differences. However, patients aged <12 years exhibited significant more critical events, primarily hypoglycemia compared to adolescents (hypoglycemia/case 2.4 ± 2.7 vs 0.9 ± 2.0; P < 0.001).
Our protocol for IV insulin therapy proved to be appropriate for adequate glycemic control in pediatric patients with T1D during intercurrent illness and surgery. However, the regime seems to be more suitable in adolescents. We adapted our protocol in younger patients with reduction of the insulin dose.
在小儿 1 型糖尿病（T1D）患者并发疾病和手术期间，持续静脉（IV）胰岛素输注治疗可最大程度地减少血糖（BG）波动并防止代谢恶化。 然而，这种情况下关于适当补液和胰岛素替代的数据很少。 我们根据当地方案评估了 IV 胰岛素治疗的有效性和安全性。
回顾性研究了 62 例 T1D 患者中因并发疾病（n=78）或小手术（n=46）而接受 IV 胰岛素治疗的 124 例住院患者（平均年龄：9.6±5.4 岁）。 患者接受葡萄糖电解质输注和短效胰岛素（常规胰岛素）。 根据每小时测量的 BG 调整输注率。 根据年龄、糖化血红蛋白（HbA1c）和住院原因对亚组进行分组，分析血糖控制情况。
平均输注时间为 22 小时（范围 1.5-147 小时）。 在 65%的输注时间内，患者的 BG 处于目标范围内（4-8 mmol/L）。 在 6%的输注时间内发现了危急事件（BG <3 或> 15 mmol/L）。 对 HbA1c 和住院原因的亚组进行血糖控制比较，未见显著差异。 然而，年龄<12 岁的患者发生危急事件的比例明显更高，主要是低血糖，与青少年相比（低血糖/例 2.4±2.7 与 0.9±2.0；P<0.001）。
我们的 IV 胰岛素治疗方案被证明适用于 T1D 小儿并发疾病和手术期间的血糖控制。 然而，该方案在青少年中似乎更适用。 我们在年龄较小的患者中减少了胰岛素剂量，对方案进行了调整。
