Department of Endocrinology & Metabolism, Second Xiangya Hospital, Central South University, Changsha 410011.
Department of Endocrinology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang Henan 471003, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Apr 28;47(4):462-468. doi: 10.11817/j.issn.1672-7347.2022.210524.
Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability.
A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema.
HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all <0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) (=0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all <0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all <0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, <0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, <0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, =0.006), MAGE was lower (=0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, =0.046), TIR was significantly higher (58% vs 47%, <0.001), and MAGE was lower (<0.001) than those in the low scan rate (<14 times/d) group.
The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.
由于胰岛β细胞破坏和绝对胰岛素缺乏，经典 1 型糖尿病（T1DM）患者需要终身依赖外源性胰岛素治疗。在中国，T1DM 约占儿童糖尿病的 90%，发病率呈快速上升趋势，且发病年龄趋于年轻化。流行病学研究表明，中国儿童 T1DM 的总体糖化血红蛋白（HbA1c）和依从率均较低。血糖控制达标是糖尿病治疗的关键，将血糖维持在目标范围内可预防或延缓 T1DM 患者的慢性血管并发症。因此，本研究旨在使用瞬态血糖监测系统（FGMS）评估来自湖南和河南的 T1DM 儿童的血糖控制情况，并探讨血糖变异性的相关影响因素。
连续纳入 2017 年 8 月至 2020 年 8 月期间来自 16 家医院的 215 名年龄＜14 岁的 T1DM 患儿。所有受试者均佩戴 FGMS 设备以收集血糖数据。分析 HbA1c、糖尿病病程或血糖扫描率与血糖变异性的相关性。根据糖尿病病程、HbA1c、血糖扫描率和胰岛素方案对血糖变异性进行比较。
HbA1c 和糖尿病病程与平均血糖、血糖标准差、平均血糖波动幅度（MAGE）和血糖变异系数（CV）呈正相关（均＜0.01）。FGMS 佩戴期间的血糖扫描率与血糖达标时间（TIR）呈显著正相关（=0.001），与 MAGE 和平均低血糖时间呈负相关（均＜0.01）。病程≤1 年的患儿时间在目标范围内（TBR）和 MAGE 低于病程＞1 年的患儿（均＜0.05）。HbA1c≤7.5%组的 TIR 和 TBR 更高（TIR：65%比 45%，TBR：5%比 4%，均＜0.05），MAGE 更低（7.0 mmol/L 比 9.4 mmol/L，＜0.001）。与多次皮下胰岛素注射组相比，持续皮下胰岛素输注组的 TIR 更高（60%比 52%，=0.006），MAGE 更低（=0.006）。高扫描率（≥14 次/d）组的 HbA1c 更低（7.4%比 8.0%，=0.046），TIR 显著更高（58%比 47%，＜0.001），MAGE 更低（＜0.001）。
湖南和河南 14 岁以下 T1DM 患者的整体血糖控制处于低血糖和较大血糖变异性的高风险中。较短的糖尿病病程、目标 HbA1c、较高的血糖扫描率和 CSII 与较低的血糖变异性相关。
