Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Bonn, Germany.
Central Institute for Biomedical Technology (ZIBMT), Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
J Diabetes. 2021 Nov;13(11):930-939. doi: 10.1111/1753-0407.13207. Epub 2021 Jul 12.
Available basal insulin regimes differ in pharmacokinetic profiles, which may be related to subsequent changes in anthropometry in patients with type 1 diabetes. This analysis elucidates the standardized height and body mass index development (height and BMI standard deviation score [height-SDS and BMI-SDS]) in pediatric type 1 diabetes patients depending on the choice of basal insulin.
Longitudinal data of 10 338 German/Austrian patients from the Diabetes Prospective Follow-up (DPV, Diabetes Patienten Verlaufsdokumentation) database were analyzed. Patients aged 5.0 to 16.9 years were treated exclusively with neutral protamine Hagedorn (NPH), insulin detemir (IDet), insulin glargine (IGla), or continuous subcutaneous insulin infusion (CSII) for at least 3 years. Population-based German reference data were used to calculate height-SDS and BMI-SDS. Multiple linear regression was conducted.
BMI-SDS increased significantly in all regimes (NPH P = .0365; IDet P = .0003; IGla P < .0001; and CSII P < .0001). Direct comparison of the therapies revealed a favorable association only for NPH vs IGla. A rise in BMI-SDS was observed for all insulins in females, but only for IGla in males. BMI-SDS increment was not observed before 8 years of age. Initially and at the end of the observation period, mean height was above the 50th percentile of the reference population. Across the cohort, height-SDS declined during the observation period, except for CSII. Apart from the 5.0- to 7.9-year-old subgroup, long-acting insulin analogues were associated with a significant loss of height-SDS.
Choice of basal insulin regimen might influence height development. CSII appeared to have a favorable effect on growth trajectories. All therapies were associated with an increase of BMI-SDS, most evident in females.
不同基础胰岛素方案的药代动力学特征不同，这可能与 1 型糖尿病患者随后的人体测量学变化有关。本分析根据基础胰岛素的选择，阐明了儿科 1 型糖尿病患者的标准化身高和体重指数发育（身高和体重指数标准差评分[身高-SDS 和 BMI-SDS]）。
对来自德国/奥地利糖尿病前瞻性随访（DPV，Diabetes Patienten Verlaufsdokumentation）数据库的 10338 名患者的纵向数据进行了分析。年龄在 5.0 至 16.9 岁的患者至少接受了 3 年的中性鱼精蛋白锌胰岛素（NPH）、地特胰岛素（IDet）、甘精胰岛素（IGla）或持续皮下胰岛素输注（CSII）治疗。使用基于人群的德国参考数据计算身高-SDS 和 BMI-SDS。进行了多元线性回归分析。
所有方案的 BMI-SDS 均显著增加（NPH P=0.0365；IDet P=0.0003；IGla P<0.0001；CSII P<0.0001）。直接比较治疗方法仅显示 NPH 与 IGla 之间存在有利关联。女性中所有胰岛素均观察到 BMI-SDS 升高，但仅在男性中观察到 IGla 升高。在 8 岁之前未观察到 BMI-SDS 增加。在观察期的开始和结束时，平均身高均高于参考人群的第 50 百分位。在整个队列中，除了 CSII 之外，身高-SDS 在观察期间下降。除了 5.0-7.9 岁年龄组外，长效胰岛素类似物与身高-SDS 的显著丧失有关。
基础胰岛素方案的选择可能会影响身高发育。CSII 似乎对生长轨迹有有利影响。所有治疗方法均与 BMI-SDS 的增加相关，女性更为明显。
