Kent L A, Gill G V, Williams G
Diabetic Clinic, Royal Liverpool University Hospital, UK.
Lancet. 1994 Sep 17;344(8925):778-81. doi: 10.1016/s0140-6736(94)92340-x.
The long-term outlook of patients with brittle insulin-dependent diabetes is uncertain. We assessed the outcome of a group of young female patients with diabetes and recurrent ketoacidosis originally investigated in 1979-85 and reassessed after a mean of 10.5 (SD 1.4) years. 7 of the 33 patients could not be traced. 5 (19%) of the remaining 26 had died. Causes of death were not certain, but were probably ketoacidosis (2), hypoglycaemia (2), and renal failure (1). Of the 21 survivors, only 2 (10%) were still considered to have brittle diabetes. Diabetic complications were common (67%), and were more frequent than in a matched control group of stable patients with diabetes (25%). Brittle diabetic patients also had lower quality-of-life scores, more frequent psychosocial disruptions, and were on higher insulin doses (77 [39] vs 47 [15] U per day, p = 0.007) than controls. Pregnancy complications had occurred in 13 of 28 (46%) pregnancies in severely unstable patients compared with 2 of 27 (7%) in stable controls. Patients with brittle diabetes have a tendency to become more stable with time, but have a higher risk of death, more microvascular and pregnancy complications, and a poorer quality of life.
脆性胰岛素依赖型糖尿病患者的长期预后尚不确定。我们评估了一组年轻女性糖尿病患者的预后情况，这些患者曾反复发生酮症酸中毒，最初于1979年至1985年接受调查，平均10.5（标准差1.4）年后进行重新评估。33例患者中有7例无法追踪到。其余26例中有5例（19%）死亡。死亡原因尚不确定，但可能是酮症酸中毒（2例）、低血糖（2例）和肾衰竭（1例）。在21名幸存者中，只有2例（10%）仍被认为患有脆性糖尿病。糖尿病并发症很常见（67%），且比一组匹配的稳定糖尿病患者对照组（25%）更频繁。脆性糖尿病患者的生活质量得分也较低，心理社会干扰更频繁，胰岛素剂量也高于对照组（每天77[39]单位对47[15]单位，p = 0.007）。严重不稳定患者的28次妊娠中有13次（46%）发生了妊娠并发症，而稳定对照组的27次妊娠中有2次（7%）发生了妊娠并发症。脆性糖尿病患者随着时间推移有趋于更稳定的倾向，但死亡风险更高，微血管和妊娠并发症更多，生活质量更差。
