初发1型糖尿病患儿血脂水平观察及其影响因素分析

目的　分析初发1型糖尿病 （T1DM） 患儿的血脂状态,并对其影响因素进行研究。方法　将 2012-01-01—2017-12-31于中国医科大学附属盛京医院新确诊的 348 例 T1DM 患儿临床资料进行收集和汇总,比较T1DM 患儿与 40 例对照组儿童的血脂差异。对 T1DM 患儿根据血脂水平分为血脂正常组（n＝153）与血脂异常组（n＝195）,比较两组患儿血脂各项指标差异。根据 糖化血红蛋白（HbA1c）值分为＜11.5%（n＝116）、11.5%～13.5%（n＝109）、＞13.5%（n＝123）3组,比较3组患儿间的血脂差异等。结果　（1）T1DM 患儿的总胆 固醇（ TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、载脂蛋白B（ApoB）等显著高于对照组,而高密度脂蛋白（ HDL）、载脂蛋白A1（ApoA1）显著低于对照组。结果为 TC（mmol/L）（4.29±1.07 vs. 3.85±0.67,P＜0.05）、 TG（mmol/L）（1.29±1.40 vs. 0.82±0.50,P＜0.01）、LDL（mmol/L）（2.61±0.91 vs. 2.17±0.57,P＜0.01）等。（2）T1DM 患儿血脂异常发生率为 56.03%,血脂异常组患儿 HbA1c （%）显著高于血脂正常组（12.93±2.16 vs. 12.10±2.37,P＜0.01）。（3）HbA1c 越大的患儿其 TC、TG、LDL等越高。结果为 TC（mmol/L）（3.96±0.78 vs. 4.12±0.94 vs. 4.75±1.25,P＜0.01）、TG（mmol/L）（0.91±0.50 vs. 1.38±1.72 vs. 1.56±1.60,P＜0.01）、LDL（mmol/L）（2.34±0.72 vs. 2.38±0.73 vs. 3.05±1.03,P＜0.01）。结论　T1DM患儿的血脂异常发病率较正常儿童明显增高;血糖越高的患儿其血脂异常状态越明显。     

1型糖尿病青少年患者血糖控制和糖尿病微血管并发症

为了解1型糖尿病青少年患者的血糖控制情况、糖尿病微血管并发症的发生率及其危险因素 ,调查病程5年以上的1型糖尿病患者76例 ,平均年龄17.2±3.9岁 ,平均病程9.0±3.4年 ,检测餐后2小时血糖、糖化血红蛋白 (HbA1C)、尿微量白蛋白 ,眼底荧光造影等。结果显示 ,HbA1C 平均水平为 (9.7±1.7) % ;糖尿病肾病发生率为9.2% ,微量白蛋白尿 (UAER :20～200μg/min)和大量蛋白尿 (UAER>200μg/min)分别占7.9 %和1.3 %;糖尿病视网膜病变发生率为23.7% ,非增殖型16例占21.1% ,增殖型2例占2.6 % ,其中3例合并白内障。提示目前1型糖尿病青少年患者的血糖控制不理想 ,仅有18.4 %的患者HbA1C <8 % ;长病程、女性、血糖控制差是1型糖尿病青少年发生糖尿病视网膜病变、糖尿病肾病的危险因素     

1型糖尿病患儿反复发生酮症酸中毒的原因

目的　分析 1型糖尿病患儿反复发生酮症酸中毒 (DKA)的原因。方法　回顾总结 2 0年来在我院诊治的 1型糖尿病患儿 85 0例次 ,其中因DKA住院 2 2 5例次 ,2次或 2次以上者 5 6例 ,131例次 ,将其分为前 10年和后 10年两组进行分析。结果　两组DKA患儿占总糖尿病人数比率及反复发生DKA人数相比有显著差异 ,后 10年显著少于前 10年 (P <0 .0 1)。在诱因方面感染占第 1位 ,平均 71.8% ;不控制饮食而暴饮暴食 19% ;因停用胰岛素 9.2 % ,两组相比无显著差异 (P >0 .0 5 )。结论　对糖尿病病人进行系统的管理和教育是降低DKA发生率的重要手段     

Clinical presentation of type 1 diabetes

OBJECTIVE: To identify the presenting features of type 1 diabetes in a national incident cohort aged under 15 yr, the duration of symptoms, the occurrence of diabetic ketoacidosis (DKA) at presentation, and the frequency of a family history of diabetes. METHODS: A prospective study was undertaken of incident cases of type 1 diabetes using an active monthly reporting card system from January 1, 1997 to December 31, 1998 in the Republic of Ireland. Follow-up questionnaires were distributed to pediatricians nationally. RESULTS: Two hundred and eighty-three incident cases were identified. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age categories. Nocturnal enuresis was reported in 19% under 5 yr and in 31% aged 5-9.99 yr. Constipation was noted in five patients and in 10.4% under 5 yr of age. The median duration of symptoms was highest in the youngest (under 2 yr) and oldest (10-14.99 yr) age categories. Presentation in moderate/severe DKA occurred in 25% overall and six of nine of those aged under 2 yr. A family history of type 1 diabetes in a first-degree relative was found in 10.2%. CONCLUSIONS: This study confirms the abrupt onset of type 1 diabetes, the absence of a family history, and the importance of the classical symptoms of polyuria, polydipsia, and weight loss in the majority of cases. It reveals secondary enuresis as an important symptom, especially in those under 10 yr, and constipation in the under 5 yr age group. The very young (under 2 yr) are more difficult to diagnose, have more variability of symptom duration, and are more likely to present in moderate/severe DKA. A high index of suspicion aids early diagnosis.     

胰岛素泵治疗儿童1型糖尿病酮症酸中毒32例临床分析

目的 观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病酮症酸中毒(DKA)的疗效.方法 将2005-2008年收治的1型DKA患儿64例分为治疗组32例和对照组32例.治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注治疗.比较两组患儿血精变化、DKA纠正时间及住院时间.结果 治疗组血糖下降相对稳定,酸中毒纠正时间治疗组[(16.91±4.223)h]短于对照组[(23.31±3.797)h](P<0.001),且无反复.治疗过程中治疗组未出现低血糖,对照组出现1例.住院时间治疗组[(15.63±2.458)d]短于对照组[(20.88±3.348)d](P<0.001).结论 胰岛素泵持续皮下注射胰岛索治疗儿童1型糖尿病酮症酸中毒安全有效.     

Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetes

BACKGROUND: Lipoprotein (a) (Lp (a)) is an independent risk factor for coronary artery disease (CAD), a major cause of death in patients with type 1 diabetes mellitus. Both type 1 diabetes and CAD represent major problems in Kuwait. Data on the effect of metabolic control on Lp (a) in diabetic children are limited and this is particularly true for Arab children. The objectives of the present study were to analyze serum Lp (a) levels in patients with type 1 diabetes compared with non-diabetic children, taking into account the effect of glycemic control. METHODS: Circulating lipids, including Lp (a), were measured in serum samples from 60 prepubertal non-diabetic children and 58 prepubertal children with type 1 diabetes. Comparisons of Lp (a) concentrations were made between the non-diabetic and diabetic children with good to fair control (glycosylated hemoglobin (GHb) <11%) and a group of diabetic children with poor control (GHb > or = 11%). RESULTS: The mean serum Lp (a) level in all diabetic children was 187.62+160.43 mg/L, compared with 162.88+156.06 mg/L in the control group. The group of children with poor glycemic control had higher median Lp (a) levels (147.50 mg/L) than either the group of diabetic children with good to fair control (95 mg/L; P<0.028) or the group of non-diabetic children (125 mg/L; P<0.04). Moreover, 38.3% of poorly controlled diabetic children had elevated Lp (a) levels > or = 250 mg/L, compared with 12.5% of diabetic children with good to fair control and 16.7% of non-diabetic children (P<0.025 and P<0.039, respectively). No association was found between Lp (a), diabetes duration and insulin dose. CONCLUSIONS: In Arab children, highest Lp (a) levels are associated with poorest metabolic control. The prevalence of Lp (a) levels associated with cardiovascular risk is higher in poorly controlled diabetic children. Increased levels of Lp (a) may be another contributing factor to the high risk for CAD in diabetic patients.     

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??Abstract?? Objective To investigate the occurrance of DKA in established T1DM children. Methods According to the registration system in the following-hospitals??Beijing Children’s Hospital of Capital Medical University?? Children’s Hospital of Shanghai?? Nanjing Children’s Hospital??Children’s Hospital of Zhengzhou?? Children’s Hospital of Jiangxi?? the First Affiliated Hospital of Xi’an Jiaotong University??First Affiliated Hospital of Kunming Medical University?? Children’s Hospital of Wuhan?? SooChow University Affiliated Children’s Hospital?? Children’s Hospital of Liaocheng?? Children’s Hospital of Fuzhou?? Chengdu Women & Children’s Central Hospital???? we investigated the frequency and cause of DKA in children with established T1DM from December 1995 to June 2014. After the diagnosis of T1DM?? the first time DKA was for group 1A?? the second DKA for group 1B. We conducted a cross-sectional survey of blood glucose control status for patients with T1DM from December 2011 to May 2012 in Beijing Children’s Hospital. Patients who did not have DKA episode in the course of T1DM were selected as control group ??group 2??. Results Totally 1676 children were newly diagnosed with T1DM by 12 hospitals?? and 89 patients occurred 100 DKA after T1DM diagnosed. The incidence and frequency of DKA was 5.3% ??89/1676?? and 5.9% ??100/1676??. The frequency was different in 12 hospitals?? fluctuating between 1.1% and 24.1%. Compared with group 2?? group 1A had high level of HbA1c ???11.31±3.03??% vs. ??8.26±1.53??%?? P??0.01?? and insulin dosage ???0.85±0.42?? IU vs. ??0.71±0.31?? IU?? P??0.01??. There were more patients with insulin bump in group 1A than group2 ??25.0% vs. 11.2%?? P??0.01???? and few patients reached the standard of blood glucose monitoring ??12.1% vs.40.1%?? P??0.01?? and follow-up ??21.2% vs. 46.6%?? P??0.01??. The main reasons of DKA in group 1A were infection ??33.7%???? interrupting insulin therapy ??21.3%?? and eating disorder ??20.2%???? one patient had DKA after islet stem cell transplantation. Infection was also the major cause of DKA in group 1B ??4/10???? and 1 patient had DKA because of insulin bump failure. For DKA which occurred within different course?? the distribution of causes was different ??P??0.01??. Within 1 year of T1DM duration?? the major reason was interrupting insulin injection ??39.3%??. For patients more than 1 year?? it only accounted for 13.1%??8/61???? the major causes were infection ??22/61?? and eating disorder ??16/61??. The major cause in mutiple hospitals with high DKA frequency was infection ??50.0%???? while in other hospitals 28.1% of patients had DKA because of infection ??P??0.01??. Conclusion The frequency of DKA is 5.3%?? which is different in 12 hospitals?? with the highest up to 24.1%. Patients with DKA have poor glycemic control?? and they can not regularly monitor blood glucose and follow-up. We should emphasize the education of diabetes. Patients with insulin pump and islet stem cell transplantation must also become a new focus of education. Hospitals with high DKA frequency should give patients information how to deal with other diseases.     

25-羟维生素D与儿童1型糖尿病及酮症酸中毒的相关性研究

目的探讨血清25-羟维生素D[25-(OH)D]水平与儿童1型糖尿病(T1DM)及酮症酸中毒(DKA)的相关性。方法选取2006年1月—2009年12月期间152例住院患儿,其中52例为首次发病的T1DM患儿,包括酮症酸中毒(DKA组)21例,以及非酮症酸中毒(非DKA组)31例,其余100例为非T1DM组。检测并比较三组患儿的血清25-(OH)D水平,分析血清25-(OH)D水平与儿童T1DM及DKA的相关性。结果 DKA组患儿的血清25-(OH)D平均为(53.6±27.8)nmol/L,显著低于非DKA组的(69.7±27.9)nmol/L和非T1DM组的(81.8±28.3)nmol/L(P<0.05);非DKA组患儿的血清25-(OH)D水平显著低于非T1DM组(P<0.05)。结论 T1DM患儿的血清25-(OH)D水平低,尤以DKA患儿最为明显,维生素D在儿童T1DM发病中的潜在保护效应值得关注。     

Insulin detemir improves glycemic control and reduces hypoglycemia in children with type 1 diabetes: findings from the Turkish cohort of the PREDICTIVE™ observational study

Background: Insulin detemir is a basal insulin analog designed to produce a superior pharmacokinetic profile to basal formulations of human insulin. It has shown consistently improved tolerability in comparison to neutral protamine Hagedorn (NPH) insulin in adult cohorts, but there are relatively few publications involving pediatric cohorts. Methods: The efficacy and safety of insulin detemir in children with type 1 diabetes was assessed using data from the Turkish cohort of PREDICTIVE? (a large, multinational, observational) study. The children investigated were using basal–bolus therapy involving NPH insulin or insulin glargine at baseline but were switched to insulin detemir as part of routine clinical care by their physicians. Results: Twelve weeks of treatment with insulin detemir significantly reduced mean hemoglobin A1c (9.7–8.9%, p < 0.001) and mean fasting glucose [185–162 mg/dL (10.3–9 mmol/L), p < 0.01]. Fasting glucose variability was also lower after treatment with insulin detemir than previously (on either NPH or glargine, p < 0.05). The frequencies of total, major and nocturnal hypoglycemic events were significantly reduced with insulin detemir relative to baseline, with an estimated mean of 6.89 fewer events/patient/yr overall (p < 0.001) and 2.6 fewer nocturnal events/patient/yr (p < 0.01). Weight and insulin dose remained relatively unchanged. Conclusions: Twelve weeks of treatment with insulin detemir improved glycemic control and reduced hypoglycemia in children with type 1 diabetes. This improved tolerability might allow further dose titration and therefore additional improvements in glucose control.     

Influence of plasma glucagon levels on glycemic control in children with type 1 diabetes

Objective: The aim of this study was to investigate the association between plasma glucose (PG), HbA1c and plasma glucagons levels in children with type 1 diabetes to determine the influence of plasma glucagon on their glycemic control. Methods: The study was conducted in 60 Japanese children, aged 13.3 ± 4.6 years, with type 1 diabetes for at least 3 years of diabetes. Most of the subjects had absent pancreatic β‐cell function. We compared the glucagon levels among patient groups stratified according to the 2‐hour postprandial levels (<50, 50–99, 100–199, 200–299, and ≥300 mg/dL), and the HbA1c levels (<7.0, 7.0–7.9, 8.0–8.9, and ≥9%). Results: The mean 2‐hour postprandial PG, HbA1c and plasma glucagon levels were 174 ± 97 mg/dL, 7.7 ± 1.3% and 84.0 ± 32.6 pg/mL, respectively. The glucagon levels were highly correlated with the PG levels (r = 0.553, P < 0.0001) and mildly correlated with the HbA1c levels (r = 0.301, P = 0.0192). Patients with high PG levels had significantly higher levels of glucagon as compared with those with lower PG levels (139.4 ± 47.2, 78.4 ± 17.3, 82.4 ± 21.0, 98.3 ± 29.2 and 93.8 ± 18.3 pg/mL, P = 0.0009). On the other hand, there were no significant differences in plasma glucagon levels among patient groups stratified according to HbA1c levels (P = 0.1566), however, patients with HbA1c levels ≥ 9% had significantly higher levels of glucagon than those with HbA1c levels < 7% (113.3 ± 53.4 vs 80.8 ± 18.4 pg/mL, P = 0.0291). Conclusion: These results suggest that patients with high PG are likely to have high concentrations of plasma glucagon, which may aggravate glycemic control progressively, leading to elevation of HbA1c levels.