[2019冠状病毒病封锁措施对1型糖尿病儿童及青少年血糖控制的影响]
[Impact of COVID-19 lockdown on glucemic control in children and adolescents with type 1 diabetes mellitus].
作者信息
Sánchez Conejero María, González de Buitrago Amigo Jesús, Tejado Bravo María Luz, de Nicolás Jiménez Jorge M
机构信息
Servicio de Pediatría, Hospital San Pedro de Alcántara, Cáceres, España.
Servicio de Pediatría, Hospital San Pedro de Alcántara, Cáceres, España.
出版信息
An Pediatr (Engl Ed). 2021 Jan 23;97(1):22-9. doi: 10.1016/j.anpedi.2020.12.021.
BACKGROUND AND AIMS
To face the rapid spread of SARS-CoV-2 coronavirus pandemic, home lockdown in Spain was decreed on 15th March 2020. The main objective of this study is to evaluate the impact of this constraint on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D).
PATIENTS AND METHODS
Observational, retrospective study in children and adolescents with T1D users of interstitial glucose monitoring systems. The following information corresponding to the last 2 weeks of lockdown was collected for subsequent comparison with data of 2 weeks prior to quarantine: daily insulin needs, mean interstitial glucose, estimated HbA1c, coefficient of variation (CV), time in range (70-180mg/dl), hypoglycemia (<70 and <54mg/dl), and hyperglycemia (>180 and>250mg/dl), sensor use and number of blood glucose measurements. Data about meal routines, physical exercise, need for adjustments in therapy, acute complications, and lockdown of caregivers were assessed via a survey.
RESULTS
80 patients were studied (mean age 12.61±3.32 years, mean time of evolution of the disease 5.85±3.92 years), 66.2% treated with an insulin pump, users of following glucose monitoring systems: Guardian 3 (65%), FreeStyle Libre (18.8%) and Dexcom G6 (16.2%). Time in range in the cohort increased significantly during confinement (72.1±10.5 vs. 74.8±10.5%; P=.011) with lower time in hypoglycemia both<70mg/dl (4.6±3.2 vs. 3.2±2.7%; P<.001) and<54mg/dl (1.2±1.6 vs. 0.7±1.2%; p<0.001) and hyperglycemia >250mg/dl (4.6±3.9 vs. 3.7±3.7%; P=.038). CV also decreased (35.8±6.3 vs. 33.1±6.1%; P<.001). Patients treated with multiple doses of insulin and poorer baseline glycemic control experienced greatest improvement. Daily insulin requirements remained stable. Regular practice of physical exercise and caregivers' confinement did not have a significant impact.
CONCLUSIONS
Glycemic control in children and adolescents with T1D improved during quarantine, particularly in those with worse baseline control.
背景与目的
为应对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行的迅速蔓延，西班牙于2020年3月15日颁布了居家隔离令。本研究的主要目的是评估这一限制措施对1型糖尿病（T1D）儿童和青少年血糖控制的影响。
患者与方法
对使用组织间葡萄糖监测系统的T1D儿童和青少年进行观察性回顾性研究。收集了与隔离最后2周相对应的以下信息，以便随后与隔离前2周的数据进行比较：每日胰岛素需求量、平均组织间葡萄糖、估计糖化血红蛋白（HbA1c）、变异系数（CV）、血糖在正常范围（70 - 180mg/dl）的时间、低血糖（<70和<54mg/dl）、高血糖（>180和>250mg/dl）、传感器使用情况以及血糖测量次数。通过一项调查评估了有关饮食规律、体育锻炼、治疗调整需求、急性并发症以及照顾者隔离的相关数据。
结果
共研究了80例患者（平均年龄12.61±3.32岁，疾病平均病程5.85±3.92年），66.2%使用胰岛素泵治疗，使用以下葡萄糖监测系统：Guardian 3（65%）、FreeStyle Libre（18.8%）和Dexcom G6（16.2%）。在隔离期间，队列中血糖在正常范围的时间显著增加（72.1±10.5%对74.8±10.5%；P = 0.011），低血糖时间（<70mg/dl时为4.6±3.2%对3.2±2.7%；P < 0.001，<54mg/dl时为1.2±1.6%对0.7±1.2%；P < .001）和高血糖（>250mg/dl时为4.6±3.9%对3.7±3.7%；P = 0.038）均减少。CV也有所下降（35.8±6.3%对33.1±6.1%；P < 0.001）。接受多次胰岛素注射且基线血糖控制较差的患者改善最为明显。每日胰岛素需求量保持稳定。规律的体育锻炼和照顾者的隔离没有显著影响。
结论
在隔离期间，T1D儿童和青少年的血糖控制得到改善，尤其是那些基线控制较差的患者。
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