与 2 型糖尿病（T2DM）患儿相比，混合型糖尿病（HD）患儿的临床和代谢特征：一项初步的对比研究。
Clinical and metabolic characteristics of children with hybrid diabetes mellitus (HD) compared to children with type 2 diabetes mellitus (T2DM): A preliminary comparative study.
机构信息
Quisisana Hospital, Ferrara.
Department of Pediatric Endocrinology, Hamad General Hospital, Doha, Qatar. .
出版信息
Acta Biomed. 2021 Nov 3;92(5):e2021511. doi: 10.23750/abm.v92i5.11598.
BACKGROUND
The term double diabetes or "Hybrid Diabetes (HD)" describes diabetes with combined features of type 1 and type 2 diabetes (T2DM).
PATIENTS AND METHODS
We report the clinical and biochemical characteristics of 7 children with HD and the course of their disease including the response to treatment. The data were compared to 59 children with a diagnosis of T2DM. Variables examined included age, height, weight, body mass index (BMI), triglycerides (Tg), high-density lipoprotein (HDL), and blood pressure. The Weiss criteria were used to diagnose metabolic syndrome (MetS). The atherogenic index of plasma (AIP) was calculated from the standard lipid profile. Four autoantibodies against pancreatic β-cell were measured in all patients.
RESULTS
Significant clinical and biochemical differences were detected among children with HD versus T2DM. The mean BMI of children with T2DM was significantly higher than for the HD group. At presentation, the mean C peptide level was significantly lower in HD versus T2DM group and 28% presented with diabetic ketoacidosis (DKA). The percentage of those with full criteria of MetS was significantly higher in T2DM versus HD group as well as the percentage of children with high atherogenic index. After a mean duration of 2.3 months from diagnosis, 4/7 of HD patients stopped insulin therapy and 3 patients had a marked reduction in the insulin requirement. During the follow-up (after 15 ±5 months), 5/7 HD patients required an increase in their insulin dose, one was controlled on a markedly low dose of basal insulin and the last patient did not require any insulin therapy for 40 months.
CONCLUSION
Appropriate assessment of HD is necessary for early and correct diagnosis. Increasing awareness of HD among the general population and primary care practitioners is necessary for successfully and properly treating this complex disease.
背景
“双重糖尿病”或“混合性糖尿病（HD）”一词描述了同时具有 1 型和 2 型糖尿病（T2DM）特征的糖尿病。
患者和方法
我们报告了 7 例 HD 患儿的临床和生化特征及其疾病过程，包括对治疗的反应。将这些数据与 59 例 T2DM 患儿进行比较。检查的变量包括年龄、身高、体重、体重指数（BMI）、甘油三酯（Tg）、高密度脂蛋白（HDL）和血压。Weiss 标准用于诊断代谢综合征（MetS）。从标准血脂谱计算血浆致动脉粥样硬化指数（AIP）。所有患者均测量了 4 种针对胰岛β细胞的自身抗体。
结果
HD 患儿与 T2DM 患儿之间存在显著的临床和生化差异。T2DM 患儿的平均 BMI 明显高于 HD 组。在初诊时，HD 组的 C 肽水平明显低于 T2DM 组，28%的患儿出现糖尿病酮症酸中毒（DKA）。T2DM 组符合 MetS 全部标准的比例以及高致动脉粥样硬化指数的患儿比例明显高于 HD 组。从诊断到确诊后 2.3 个月的平均时间，7 例 HD 患儿中有 4 例停止胰岛素治疗，3 例胰岛素需求明显减少。在随访期间（15±5 个月后），5/7 的 HD 患儿需要增加胰岛素剂量，1 例患者需要的基础胰岛素剂量明显减少，最后 1 例患者 40 个月无需任何胰岛素治疗。
结论
需要对 HD 进行适当评估，以实现早期、正确诊断。提高普通人群和初级保健医生对 HD 的认识，对于成功、正确治疗这种复杂疾病非常必要。
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