Jacobs M L, Elte J W, van Ouwerkerk B M, Janssens E N, Schop C, Knoop J A, Hoogma R P, Groenendijk R, Weber R F
Department of Internal Medicine III, University Hospital Dijkzigt, Rotterdam, Netherlands.
Neth J Med. 1997 Apr;50(4):153-9. doi: 10.1016/s0300-2977(97)00008-9.
Strict glucose control is essential to the prevention of diabetic complications. The level of glycaemic control in insulin-treated patients with diabetes mellitus (DM) in a routine clinical setting is not known.
In a cross-sectional survey comprising 8 hospitals in the Rijnmond area, The Netherlands, age, body mass index (BMI), insulin dose, number of injections, and HbA1c were scored in 712 patients with insulin-dependent DM (IDDM) and 462 patients with non-insulin-dependent DM (NIDDM).
In IDDM and NIDDM patients, respectively, age (mean +/- SD) was 40 +/- 17 and 65 +/- 12 years, BMI was 24.1 +/- 3.5 and 27.3 +/- 4.1 kg/m2, daily insulin dose was 49 +/- 18 and 44 +/- 18 U (P < 0.001). Intensive therapy (> or = 4 injections or continuous subcutaneous insulin infusion) was used in 59% of IDDM and 13% of NIDDM patients. HbA1c below the upper normal limit was achieved in 11% of the patients, and within 20% above the upper normal limit in 37%. Obesity was positively associated with HbA1c in NIDDM patients (P < 0.01). A higher insulin dose was associated with higher HbA1c in both IDDM and NIDDM patients (P < 0.01).
Good glycaemic control was established in 37% of our patients. Intensive insulin treatment and higher insulin dose did not improve glucose regulation. Obesity is a risk factor for poor glycaemic control.
严格控制血糖对于预防糖尿病并发症至关重要。在常规临床环境中，接受胰岛素治疗的糖尿病患者的血糖控制水平尚不清楚。
在荷兰莱茵蒙德地区8家医院开展的一项横断面调查中，对712例胰岛素依赖型糖尿病（IDDM）患者和462例非胰岛素依赖型糖尿病（NIDDM）患者的年龄、体重指数（BMI）、胰岛素剂量、注射次数和糖化血红蛋白（HbA1c）进行了记录。
IDDM患者和NIDDM患者的年龄（均值±标准差）分别为40±17岁和65±12岁，BMI分别为24.1±3.5kg/m²和27.3±4.1kg/m²，每日胰岛素剂量分别为49±18U和44±18U（P<0.001）。59%的IDDM患者和13%的NIDDM患者采用强化治疗（≥4次注射或持续皮下胰岛素输注）。11%的患者HbA1c低于正常上限，37%的患者HbA1c高于正常上限20%以内。在NIDDM患者中，肥胖与HbA1c呈正相关（P<0.01）。在IDDM患者和NIDDM患者中，较高的胰岛素剂量均与较高的HbA1c相关（P<0.01）。
我们的患者中有37%实现了良好的血糖控制。强化胰岛素治疗和较高的胰岛素剂量并未改善血糖调节。肥胖是血糖控制不佳的一个危险因素。
