基础胰岛素剂量与总胰岛素剂量的比例与儿童 1 型糖尿病的代谢控制、体重指数和治疗方式有关——来自国际 SWEET 登记处的横断面研究数据。
Proportion of Basal to Total Insulin Dose Is Associated with Metabolic Control, Body Mass Index, and Treatment Modality in Children with Type 1 Diabetes-A Cross-Sectional Study with Data from the International SWEET Registry.
机构信息
Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.
Department of Pediatrics, Randers Regional Hospital, Randers, Denmark; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
出版信息
J Pediatr. 2019 Dec;215:216-222.e1. doi: 10.1016/j.jpeds.2019.06.002. Epub 2019 Jul 22.
OBJECTIVES
To investigate in a large population the proportion of daily basal insulin dose (BD) to daily total insulin dose (TD) (BD/TD) and its association with glycated hemoglobin A1c (HbA1c), body mass index (BMI)- SDS, and treatment modality in children with type 1 diabetes.
STUDY DESIGN
Cross-sectional study in subjects with type 1 diabetes, age ≤18 years, and ≥2 years of diabetes duration, registered in the international multicenter Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference registry in March 2018. Variables included region, sex, age, diabetes duration, treatment modality (multiple daily injections [MDI] or continuous subcutaneous insulin infusion [CSII]), self-monitoring blood glucose, HbA1c, BD/TD, and BMI-SDS. BMI was converted to BMI-SDS using World Health Organization charts as reference. Hierarchic linear regression models were applied with adjustment for age, sex, and diabetes duration.
RESULTS
A total of 19 687 children with type 1 diabetes (49% female, 49% CSII users) with median age 14.8 (11.5; 17.2) years and diabetes duration 6.0 (3.9; 9.0) years were included. HbA1c was 63 (55; 74) mmol/mol (7.9 [7.2; 8.9]%), and BMI-SDS 0.55 (-0.13; 1.21). Unadjusted, a lower BD/TD was associated with lower HbA1c, male sex, younger age, shorter diabetes duration, lower BMI-SDS, higher numbers of self-monitoring blood glucose and CSII (all P < .01). After adjustment for confounders, lower BD/TD was associated with lower HbA1c (P < .01) and lower BMI-SDS (P < .01) in children on CSII, but not on MDI.
CONCLUSIONS
Lower BD/TD is positively associated with lower HbA1c and lower BMI-SDS in children with type 1 diabetes on CSII. It remains to be investigated in a prospective study whether reducing BD/TD insulin will improve metabolic control and normalize body weight in children with type 1 diabetes.
目的
在大人群中调查每日基础胰岛素剂量（BD）与每日总胰岛素剂量（TD）的比例（BD/TD），并研究其与糖化血红蛋白 A1c（HbA1c）、体重指数（BMI）-SDS 和治疗方式的相关性，这些因素在 1 型糖尿病患儿中。
研究设计
2018 年 3 月，对国际多中心 Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference 登记处登记的年龄≤18 岁且糖尿病病程≥2 年的 1 型糖尿病患儿进行横断面研究。变量包括地区、性别、年龄、糖尿病病程、治疗方式（多次皮下注射[MDI]或连续皮下胰岛素输注[CSII]）、自我监测血糖、HbA1c、BD/TD 和 BMI-SDS。BMI 采用世界卫生组织图表转换为 BMI-SDS。采用层次线性回归模型，调整年龄、性别和糖尿病病程。
结果
共纳入 19687 名 1 型糖尿病患儿（49%为女性，49%为 CSII 使用者），中位年龄 14.8（11.5；17.2）岁，糖尿病病程 6.0（3.9；9.0）年。HbA1c 为 63（55；74）mmol/mol（7.9 [7.2；8.9]%），BMI-SDS 为 0.55（-0.13；1.21）。未校正时，BD/TD 较低与 HbA1c 较低、男性、年龄较小、糖尿病病程较短、BMI-SDS 较低、自我监测血糖和 CSII 次数较高有关（均 P <.01）。校正混杂因素后，CSII 治疗患儿的 BD/TD 与 HbA1c 较低（P <.01）和 BMI-SDS 较低（P <.01）呈正相关，但 MDI 治疗患儿则无相关性。
结论
BD/TD 较低与 1 型糖尿病 CSII 治疗患儿的 HbA1c 较低和 BMI-SDS 较低呈正相关。前瞻性研究仍需要进一步探讨降低 BD/TD 胰岛素是否能改善代谢控制并使 1 型糖尿病患儿体重正常化。
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