Tupola S, Rajantie J, Mäenpää J
Aurora Hospital, Helsinki, Finland.
Diabet Med. 1998 Aug;15(8):695-9. doi: 10.1002/(SICI)1096-9136(199808)15:8<695::AID-DIA651>3.0.CO;2-C.
Episodes of severe hypoglycaemia, resulting in coma and/or convulsions, were documented in an unselected, population-based group of 376 children and adolescents with Type 1 diabetes mellitus (Type 1 DM) treated at the Aurora Hospital, City of Helsinki. A prospective study in 1994-95 yielded 493 patient-years and a retrospective study in 1990-93, 904 patient-years of data. Of these patients, 77-85% received insulin in three or more daily doses. During 1990-95, 43 patients had a total of 48 severe hypoglycaemic episodes. For each episode (n = 48), one control Type 1 DM patient who had never experienced any severe hypoglycaemia, matched by age, diabetes duration and puberty, was sought from the study population. Incidence of severe hypoglycaemia was 3.1/100 patients years prospectively and 3.6/100 retrospectively. At the time of the episode, median age was 13.3 (range 2.2-21) years, and median diabetes duration 6.1 (0.5-14.6) years. Rates were similar in different age groups (< 6, 6-12.9 and > or = 13 years). A potential explanation for the hypoglycaemia was found in 79% of the episodes. Insulin dose was higher (p = 0.04) and HbA1c lower (p = 0.005) in patients with severe hypoglycaemia than in controls. In conclusion, multiple-dose insulin therapy in young patients with Type 1 DM can be associated with a low rate of severe hypoglycaemia. The majority of such episodes seem to be preventable.
在赫尔辛基市奥罗拉医院接受治疗的376名1型糖尿病（1型DM）儿童和青少年的非选择性、基于人群的队列中，记录到了导致昏迷和/或惊厥的严重低血糖发作。1994 - 1995年的一项前瞻性研究产生了493患者年的数据，1990 - 1993年的一项回顾性研究产生了904患者年的数据。在这些患者中，77 - 85%每天接受三次或更多次胰岛素注射。在1990 - 1995年期间，43名患者共发生了48次严重低血糖发作。对于每一次发作（n = 48），从研究人群中寻找一名年龄、糖尿病病程和青春期相匹配的从未经历过任何严重低血糖的1型DM对照患者。严重低血糖的发生率前瞻性为3.1/100患者年，回顾性为3.6/100。发作时，中位年龄为13.3岁（范围2.2 - 21岁），中位糖尿病病程为6.1年（0.5 - 14.6年）。不同年龄组（<6岁、6 - 12.9岁和≥13岁）的发生率相似。在79%的发作中发现了低血糖的潜在原因。严重低血糖患者的胰岛素剂量更高（p = 0.04），糖化血红蛋白更低（p = 0.005）。总之，年轻的1型DM患者采用多次胰岛素治疗可能伴有低严重低血糖发生率。这类发作中的大多数似乎是可以预防的。
